Healthcare Provider Details

I. General information

NPI: 1316234958
Provider Name (Legal Business Name): ALKETAH ROCHELL FRAZIER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2011
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HEMLOCK ST MSC 104
MACON GA
31201-2102
US

IV. Provider business mailing address

777 HEMLOCK ST MSC 104
MACON GA
31201-2102
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-7550
  • Fax: 478-633-3235
Mailing address:
  • Phone: 478-633-7550
  • Fax: 478-633-3235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number072547
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: