Provider Demographics
NPI:1235731142
Name:MONDARY, FRANK HOWARD (RN260659)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:HOWARD
Last Name:MONDARY
Suffix:
Gender:M
Credentials:RN260659
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 ANTOINETTE AVE
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-8810
Mailing Address - Country:US
Mailing Address - Phone:678-899-9674
Mailing Address - Fax:
Practice Address - Street 1:1209 GREENBELT DR
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4507
Practice Address - Country:US
Practice Address - Phone:770-358-8338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-15
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN2606592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer