Provider Demographics
NPI:1699804385
Name:FRIEDRICHS, THOMAS DONNELLY (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DONNELLY
Last Name:FRIEDRICHS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5605 GLENRIDGE DR NE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1365
Mailing Address - Country:US
Mailing Address - Phone:404-257-9991
Mailing Address - Fax:404-257-0299
Practice Address - Street 1:5605 GLENRIDGE DR NE
Practice Address - Street 2:SUITE 600
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1365
Practice Address - Country:US
Practice Address - Phone:404-257-9991
Practice Address - Fax:404-257-0299
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA327103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00052302AMedicaid
GA68BBBBTMedicare ID - Type Unspecified