Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CHIR009015 | GA |
NPI | 1972851152 |
---|---|
Provider Name | Dr. Timika Lashaun Frazier |
First Address | Marietta, GA 30067-4434 |
Second Address | Marietta, GA 30067-4434 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2012 |
Last Update Date | 20/08/2012 |