Provider Demographics
NPI:1033316641
Name:CASASCO, JULIE FRITZ (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:FRITZ
Last Name:CASASCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:FRITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 749306
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:743 FOLLY RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3432
Practice Address - Country:US
Practice Address - Phone:843-762-2360
Practice Address - Fax:843-762-2340
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC299885Medicaid
SCP01157488Medicare PIN
SCAA59617126Medicare PIN