Healthcare Provider Details

I. General information

NPI: 1104868785
Provider Name (Legal Business Name): ADAM MICHAEL FRASCH D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 GORDON AVE
THOMASVILLE GA
31792-6646
US

IV. Provider business mailing address

510 GORDON AVE
THOMASVILLE GA
31792-6646
US

V. Phone/Fax

Practice location:
  • Phone: 229-227-1997
  • Fax: 229-227-9389
Mailing address:
  • Phone: 229-227-1997
  • Fax: 229-227-9389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number00695
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: