Provider Demographics
NPI:1841093770
Name:JACKSON-FRAZIER, ROCHELL V (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:ROCHELL
Middle Name:V
Last Name:JACKSON-FRAZIER
Suffix:
Gender:
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:ROCHELL
Other - Middle Name:V
Other - Last Name:JACKSON-FRAZIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:6758 BROWNS MILL LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-4537
Mailing Address - Country:US
Mailing Address - Phone:470-504-7611
Mailing Address - Fax:
Practice Address - Street 1:6758 BROWNS MILL LAKE RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-4537
Practice Address - Country:US
Practice Address - Phone:470-504-7611
Practice Address - Fax:404-947-9432
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA08795164W00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse