Healthcare Provider Details

I. General information

NPI: 1063317089
Provider Name (Legal Business Name): FERNANDA SMITH FRASER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 CAMBRIDGE SQ STE 200
ALPHARETTA GA
30009-1844
US

IV. Provider business mailing address

628 EDGEWOOD AVE NE APT 605
ATLANTA GA
30312-2036
US

V. Phone/Fax

Practice location:
  • Phone: 678-336-6875
  • Fax:
Mailing address:
  • Phone: 914-319-2967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: