MEDICARE: DR. HEATHER RAE FRODGE D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN013327	GA

General Provider Information

NPI Number	:	1528235116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER RAE FRODGE D.M.D.

Provider Business Mailing Address
First Line	:	804 TOWN BOULEVARD
Second Line	:	SUITE 2010
City	:	ATLANTA
State	:	GA
Zip	:	30319
Country	:	US
Telephone Number	:	404-631-6277
Fax Number	:	404-631-6278

Provider Business Practice Location Address
First Line	:	804 TOWN BLVD NE
Second Line	:	SUITE 2010
City	:	ATLANTA
State	:	GA
Zip	:	30319-3147
Country	:	US
Telephone Number	:	404-631-6277
Fax Number	:	404-631-6278

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	10/26/2023

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