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Provider Information for 1891701850


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Mr. JEFFREY SCOT FRY LCSW


Sex: Male

NPI: 1891701850
Last Updated: 2011-02-02
Certification Date:

Details

NameValue
NPI1891701850
Enumeration Date2006-07-31
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 3593 BROOKEFALL CT
SUWANEE, GA 30024-7033
United States

Phone: 866-525-2128 | Fax:866-514-9557
 
Primary Practice Address 370 PROSPECT PL
ALPHARETTA, GA 30005-5467
United States

Phone: 866-525-2128 | Fax:866-514-9557
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalGACSW002889