Healthcare Provider Details

I. General information

NPI: 1750993606
Provider Name (Legal Business Name): MARIE FRYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 W MAIN ST STE 100
DOTHAN AL
36301-1626
US

IV. Provider business mailing address

107 CAITLIN CT APT 4
DOTHAN AL
36303-6753
US

V. Phone/Fax

Practice location:
  • Phone: 334-435-7838
  • Fax:
Mailing address:
  • Phone: 334-258-3580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: