Healthcare Provider Details

I. General information

NPI: 1104744036
Provider Name (Legal Business Name): OCTAVIA FRAZILE BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E PONCE DE LEON AVE STE 400
DECATUR GA
30030-3406
US

IV. Provider business mailing address

106 CHINA BERRY CT
EASLEY SC
29640-2564
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-0508
  • Fax:
Mailing address:
  • Phone: 864-569-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number259013
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: