Provider Demographics
NPI:1811999105
Name:FRANKOWIAK, RAY MICHAEL (CPO)
Entity type:Individual
Prefix:MR
First Name:RAY
Middle Name:MICHAEL
Last Name:FRANKOWIAK
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:MR
Other - First Name:RAY
Other - Middle Name:MICHAEL
Other - Last Name:FRANKOWIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPO
Mailing Address - Street 1:125 EAGLES WALK
Mailing Address - Street 2:STE 100
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7239
Mailing Address - Country:US
Mailing Address - Phone:678-565-1083
Mailing Address - Fax:678-565-1084
Practice Address - Street 1:125 EAGLES WALK
Practice Address - Street 2:STE 100
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7239
Practice Address - Country:US
Practice Address - Phone:678-565-1083
Practice Address - Fax:678-565-1084
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAC14187224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAC14187OtherCPO CERTIFICATION
GA4233540001Medicare ID - Type UnspecifiedMEDICARE I.D. NUMBER