Healthcare Provider Details

I. General information

NPI: 1073257077
Provider Name (Legal Business Name): MACY ELLEN FRAZIER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10360 MEDLOCK BRIDGE RD STE A1
JOHNS CREEK GA
30097-5927
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR FL 9
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 770-476-1220
  • Fax:
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003427
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: