Provider Demographics
NPI:1750993606
Name:FRYER, MARIE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:FRYER
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 1:107 CAITLIN CT APT 4
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-6753
Mailing Address - Country:US
Mailing Address - Phone:334-258-3580
Mailing Address - Fax:
Practice Address - Street 1:545 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1626
Practice Address - Country:US
Practice Address - Phone:334-435-7838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health