Provider Demographics
NPI:1255561379
Name:FRASER, DONESSA ARETHA (MD)
Entity type:Individual
Prefix:
First Name:DONESSA
Middle Name:ARETHA
Last Name:FRASER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2389 WESLEY CHAPEL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-2819
Mailing Address - Country:US
Mailing Address - Phone:404-469-9867
Mailing Address - Fax:877-889-5105
Practice Address - Street 1:2389 WESLEY CHAPEL RD STE 102
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-2819
Practice Address - Country:US
Practice Address - Phone:404-469-9867
Practice Address - Fax:877-889-5105
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31828207Q00000X
GA89269207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1255561379Medicaid