Provider Demographics
NPI:1588128193
Name:FRETT, OQUERIA NEON
Entity type:Individual
Prefix:PROF
First Name:OQUERIA
Middle Name:NEON
Last Name:FRETT
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 1:6101 FAIRINGTON RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-5601
Mailing Address - Country:US
Mailing Address - Phone:678-789-3585
Mailing Address - Fax:
Practice Address - Street 1:6101 FAIRINGTON RIDGE CIR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-5601
Practice Address - Country:US
Practice Address - Phone:678-789-3585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor