Provider Demographics
NPI:1801356027
Name:FREY, ALYSSA (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:FREY
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9280 SR-5 N UNIT A
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134
Mailing Address - Country:US
Mailing Address - Phone:707-949-2250
Mailing Address - Fax:
Practice Address - Street 1:100 PROFESSIONAL PL STE 202
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3802
Practice Address - Country:US
Practice Address - Phone:770-832-6861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN249615363LP2300X
TXAP141487363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX746002963OtherEMPLOYER TAX ID
TXAP141487OtherLICENSE