Healthcare Provider Details

I. General information

NPI: 1962186759
Provider Name (Legal Business Name): TATA-NISHA FRAZIER CPS-MD, AD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 FAIR ST SW
ATLANTA GA
30313-1206
US

IV. Provider business mailing address

4037 BROWNE CT
CONLEY GA
30288-6811
US

V. Phone/Fax

Practice location:
  • Phone: 470-896-6046
  • Fax:
Mailing address:
  • Phone: 404-263-2478
  • Fax: 404-973-0276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: