Provider Demographics
NPI:1306439054
Name:ATWATER, FRANCES
Entity type:Individual
Prefix:MS
First Name:FRANCES
Middle Name:
Last Name:ATWATER
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 1:133 HARBOUR LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-6638
Mailing Address - Country:US
Mailing Address - Phone:678-532-9690
Mailing Address - Fax:
Practice Address - Street 1:133 HARBOUR LAKE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-6638
Practice Address - Country:US
Practice Address - Phone:678-532-9690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-13
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA83-2147591Medicaid