Provider Demographics
NPI:1871835744
Name:FRAZIER, ASHLEY C (MED)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:C
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 COLUMBIA RD STE 2C
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0437
Mailing Address - Country:US
Mailing Address - Phone:762-685-8159
Mailing Address - Fax:
Practice Address - Street 1:4210 COLUMBIA RD STE 2C
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-0437
Practice Address - Country:US
Practice Address - Phone:762-685-8159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008820101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional