Provider Demographics
NPI:1730247412
Name:FRIEDMAN, WAYNE H (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:H
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E SHOTWELL ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-4256
Mailing Address - Country:US
Mailing Address - Phone:229-243-0152
Mailing Address - Fax:229-246-9945
Practice Address - Street 1:1501 MILULI AVE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-5700
Practice Address - Country:US
Practice Address - Phone:229-243-0152
Practice Address - Fax:229-246-9945
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41703207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3830163Medicaid
TNP00411661Medicare PIN
TN3830163Medicare PIN