Healthcare Provider Details

I. General information

NPI: 1629914833
Provider Name (Legal Business Name): SHIRLEY LORRAINE FRAZIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 MOODY RD STE 122
WARNER ROBINS GA
31088-6110
US

IV. Provider business mailing address

111 HAVELOCK CIR
WARNER ROBINS GA
31088-3113
US

V. Phone/Fax

Practice location:
  • Phone: 478-365-0847
  • Fax: 478-551-3359
Mailing address:
  • Phone: 478-508-8129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: