Healthcare Provider Details

I. General information

NPI: 1073436572
Provider Name (Legal Business Name): ALLYSSA FRASHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 LAWRENCEVILLE SUWANEE RD STE A3
SUWANEE GA
30024-7488
US

IV. Provider business mailing address

2370 SEVER RD APT 3204
LAWRENCEVILLE GA
30043-4242
US

V. Phone/Fax

Practice location:
  • Phone: 470-589-1878
  • Fax:
Mailing address:
  • Phone: 989-708-4136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number106S00000X
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: