Healthcare Provider Details

I. General information

NPI: 1093361719
Provider Name (Legal Business Name): MR. FRANK TICHORLA WAJULE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2019
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MITCHELL BRIDGE RD
ATHENS GA
30606-2043
US

IV. Provider business mailing address

3913 POTOMAC WALK CT
LOGANVILLE GA
30052-7635
US

V. Phone/Fax

Practice location:
  • Phone: 888-839-0743
  • Fax:
Mailing address:
  • Phone: 678-670-4407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN276761
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN276761
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: