Provider Demographics
NPI:1306094347
Name:FRAZIER, TRESHONDA
Entity type:Individual
Prefix:
First Name:TRESHONDA
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3695F CASCADE RD SW # 2292
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2105
Mailing Address - Country:US
Mailing Address - Phone:678-644-9188
Mailing Address - Fax:404-254-5474
Practice Address - Street 1:3695 F. CASCADE RD #2292
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331
Practice Address - Country:US
Practice Address - Phone:678-644-9188
Practice Address - Fax:678-644-9188
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005692235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA371023031EMedicaid