Collin Blake Frederick, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT003432 Issued in GA

Practice address

3005 Sardis Rd
Gainesville, GA 30506-2232

Phone

(912) 294-7908

NPI assigned

Oct 30, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540857600000",
    "number": "1770050536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "76 HORSERANGE VISTA CT",
            "city": "CLEVELAND",
            "state": "GA",
            "postal_code": "305282387",
            "telephone_number": "912-294-7908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3005 SARDIS RD",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305062232",
            "telephone_number": "912-294-7908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "COLLIN",
        "middle_name": "BLAKE",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-30",
        "last_updated": "2018-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT003432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beau Daniel Foxworth, MD
• Stephen Z Frabitore, MD
• Brandy Nicole Franklin, NP
• Kerri Anne Fraser, FNP-BC
• Gloria Mea Frazier, GLORIA FRAZIER, RBT
• Donald Freeman, MD
• Jack Freeman
• Jennifer Freeman, MS, LPC
• Karen Jeanette Freeman, FNP-C
• Stephanie E Freeman, MD

• Athletic Trainer in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Athletic Trainer in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.