Provider Demographics
NPI:1508962341
Name:FRAZEY, GEODORA A (MSN, CCRN)
Entity Type:Individual
Prefix:MRS
First Name:GEODORA
Middle Name:A
Last Name:FRAZEY
Suffix:
Gender:F
Credentials:MSN, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4561 AYLESBURY CT
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-8220
Mailing Address - Country:US
Mailing Address - Phone:706-733-0188
Mailing Address - Fax:
Practice Address - Street 1:1 FREEDOM WAY
Practice Address - Street 2:NURSING INTERDEPARTMENTAL ROUTE#31
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6258
Practice Address - Country:US
Practice Address - Phone:706-733-0188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO141238163WC0200X, 163WC1600X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Not Answered163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
Not Answered163WW0000XNursing Service ProvidersRegistered NurseWound Care