MEDICARE: TATA-NISHA FRAZIER CPS-MD, AD

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	175T00000X	Peer Specialist		GA

General Provider Information

NPI Number	:	1962186759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATA-NISHA FRAZIER CPS-MD, AD

Provider Business Mailing Address
First Line	:	4037 BROWNE CT
Second Line	:
City	:	CONLEY
State	:	GA
Zip	:	30288-6811
Country	:	US
Telephone Number	:	404-263-2478
Fax Number	:	404-973-0276

Provider Business Practice Location Address
First Line	:	504 FAIR ST SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30313-1206
Country	:	US
Telephone Number	:	470-896-6046
Fax Number	:

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

Provider Enumeration Date	:	06/12/2023
Last Update Date	:	06/12/2023

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Directions to “ TATA-NISHA FRAZIER CPS-MD, AD” Practice Location

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