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General NPI Number Information
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NPI Number | 1104744036
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Entity Type | Individual
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Provider Name | OCTAVIA FRAZILE BSN, RN
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Gender | Female
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Dates
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Enumeration Date | 07/08/2026
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Last Update Date | 07/08/2026
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Provider Practice Location Address
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Address Line | 250 E PONCE DE LEON AVE STE 400
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City | DECATUR
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State | GA
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Zip | 30030-3406
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Country | US
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Telephone | 404-251-0508
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Fax |
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Provider Business Mailing Address
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Address Line | 106 CHINA BERRY CT
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City | EASLEY
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State | SC
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Zip | 29640-2564
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Country | US
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Telephone | 864-569-7874
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 259013
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License Number State | SC
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