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NPI Code Detail

MEDICARE: KIESHA FRASER DOH MD

MEDICARE: KIESHA FRASER DOH MD
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
1208000000XPediatrics Physician67901GA

General Provider Information

NPI Number : 1730167040
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIESHA FRASER DOH MD
Provider Business Mailing Address
First Line : 1405 CLIFTON RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30322-1060
Country : US
Telephone Number : 404-785-7141
Fax Number : 404-785-7989
Provider Business Practice Location Address
First Line : 1405 CLIFTON RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30322-1060
Country : US
Telephone Number : 404-785-7141
Fax Number : 404-785-7989
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2006
Last Update Date : 06/06/2022

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Directions to “ KIESHA FRASER DOH MD” Practice Location

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