Provider Demographics
NPI:1386497113
Name:FRAZIER, BREONNA NIEMAH
Entity type:Individual
Prefix:
First Name:BREONNA
Middle Name:NIEMAH
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 1:2253 HANSON ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-1925
Mailing Address - Country:US
Mailing Address - Phone:912-713-4370
Mailing Address - Fax:
Practice Address - Street 1:785H KING GEORGE BLVD STE D1149
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-9551
Practice Address - Country:US
Practice Address - Phone:912-417-9577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker