Provider Demographics
NPI:1073979415
Name:FRAZIER, ADRON JAMES JR
Entity Type:Individual
Prefix:MR
First Name:ADRON
Middle Name:JAMES
Last Name:FRAZIER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42502 PELICAN DR
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-9211
Mailing Address - Country:US
Mailing Address - Phone:504-615-5469
Mailing Address - Fax:
Practice Address - Street 1:1320 N MORRISON BLVD STE 106
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2242
Practice Address - Country:US
Practice Address - Phone:985-551-5155
Practice Address - Fax:985-551-5222
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator