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General NPI Number Information
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NPI Number | 1427787076
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Entity Type | Individual
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Provider Name | RYAN RAYMOND DELANE FRAZIER APRN
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Gender | Male
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 4623 OGEECHEE RD STE A
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City | SAVANNAH
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State | GA
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Zip | 31405-1209
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Country | US
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Telephone | 407-921-0303
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Fax |
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Provider Business Mailing Address
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Address Line | 48 KANDLEWOOD DR
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City | SAVANNAH
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State | GA
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Zip | 31406-5884
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Country | US
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Telephone | 407-921-0303
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN284514
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License Number State | GA
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