Provider Demographics
NPI:1205500204
Name:FRIERSON, ALECIA B
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:B
Last Name:FRIERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 GREEN HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-4237
Mailing Address - Country:US
Mailing Address - Phone:843-229-7419
Mailing Address - Fax:
Practice Address - Street 1:400 MOORE ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-3314
Practice Address - Country:US
Practice Address - Phone:843-699-9127
Practice Address - Fax:843-699-9136
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHPC-1526251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health