Provider Demographics
NPI:1417646837
Name:FRAZIER, JAMARCUS B (RDN)
Entity Type:Individual
Prefix:
First Name:JAMARCUS
Middle Name:B
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8416 INVERNESS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-6568
Mailing Address - Country:US
Mailing Address - Phone:901-210-1523
Mailing Address - Fax:
Practice Address - Street 1:8416 INVERNESS DR
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-6568
Practice Address - Country:US
Practice Address - Phone:901-210-1523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4306133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered