Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | 479 | GA |
NPI | 1194092593 |
---|---|
Provider Name | Mr. Terrell Reginaldo Frazier |
First Address | Fayetteville, GA 30215-8030 |
Second Address | Fayetteville, GA 30215-8030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2011 |
Last Update Date | 28/05/2019 |