Healthcare Provider Details

I. General information

NPI: 1467371716
Provider Name (Legal Business Name): DENNIS KANE FRADY MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HODGES ST STE 203
CORNELIA GA
30531-3294
US

IV. Provider business mailing address

215 HODGES ST STE 203
CORNELIA GA
30531-3294
US

V. Phone/Fax

Practice location:
  • Phone: 706-510-1251
  • Fax: 706-510-1259
Mailing address:
  • Phone: 706-510-1251
  • Fax: 706-510-1259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: