Provider Demographics
NPI:1861528911
Name:FRIEDMAN, ANDREA (CERT SHOE FITTER)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:CERT SHOE FITTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 DAVES CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6947
Mailing Address - Country:US
Mailing Address - Phone:770-317-7179
Mailing Address - Fax:678-513-3953
Practice Address - Street 1:1940 DAVES CREEK TRL
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6947
Practice Address - Country:US
Practice Address - Phone:770-317-7179
Practice Address - Fax:678-513-3953
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies