Provider Demographics
NPI:1427787076
Name:FRAZIER, RYAN RAYMOND DELANE (APRN)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:RAYMOND DELANE
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 KANDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-5884
Mailing Address - Country:US
Mailing Address - Phone:407-921-0303
Mailing Address - Fax:
Practice Address - Street 1:4623 OGEECHEE RD STE A
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-1209
Practice Address - Country:US
Practice Address - Phone:407-921-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN284514363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty