Provider Demographics
NPI:1194249425
Name:FRAZIER, BOBBIE
Entity type:Individual
Prefix:
First Name:BOBBIE
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BOBBIE
Other - Middle Name:
Other - Last Name:FRAZIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:400 CLOVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4057
Mailing Address - Country:US
Mailing Address - Phone:229-412-3323
Mailing Address - Fax:229-213-5071
Practice Address - Street 1:400 CLOVERDALE DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792
Practice Address - Country:US
Practice Address - Phone:229-412-3323
Practice Address - Fax:229-213-5071
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA$$$$$$$$$Medicaid