Provider Demographics
NPI:1538305016
Name:CAROLYN D. FRYE, LLC
Entity Type:Organization
Organization Name:CAROLYN D. FRYE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:DELOIS
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, NCC
Authorized Official - Phone:404-629-3933
Mailing Address - Street 1:920 DANNON VW SW
Mailing Address - Street 2:SUITE 3104
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2157
Mailing Address - Country:US
Mailing Address - Phone:404-629-3933
Mailing Address - Fax:404-629-3935
Practice Address - Street 1:920 DANNON VW SW
Practice Address - Street 2:SUITE 3104
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2157
Practice Address - Country:US
Practice Address - Phone:404-629-3933
Practice Address - Fax:404-629-3935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005026251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1730354689OtherNPI 1
GA419117410AMedicaid