Healthcare Provider Details

I. General information

NPI: 1841093770
Provider Name (Legal Business Name): ROCHELL V JACKSON-FRAZIER REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROCHELL V JACKSON-FRAZIER REGISTERED NURSE

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6758 BROWNS MILL LAKE RD
LITHONIA GA
30038-4537
US

IV. Provider business mailing address

6758 BROWNS MILL LAKE RD
LITHONIA GA
30038-4537
US

V. Phone/Fax

Practice location:
  • Phone: 470-504-7611
  • Fax: 404-947-9432
Mailing address:
  • Phone: 470-504-7611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number08795
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: