Provider Demographics
NPI:1538707302
Name:FRAZIER, JOHN MARK
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MARK
Last Name:FRAZIER
Suffix:
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 1:185 CECIL LN
Mailing Address - Street 2:
Mailing Address - City:EAST RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37412-2211
Mailing Address - Country:US
Mailing Address - Phone:423-618-1496
Mailing Address - Fax:423-345-8630
Practice Address - Street 1:185 CECIL LN
Practice Address - Street 2:
Practice Address - City:EAST RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37412-2211
Practice Address - Country:US
Practice Address - Phone:423-618-1496
Practice Address - Fax:423-345-8630
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver