Basic Information
| Provider Information | |||||||||
| NPI: | 1316234958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRAZIER | ||||||||
| FirstName: | ALKETAH | ||||||||
| MiddleName: | ROCHELL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 HEMLOCK ST | ||||||||
| Address2: | MSC 104 | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312012102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4786337550 | ||||||||
| FaxNumber: | 4786333235 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 HEMLOCK ST | ||||||||
| Address2: | MSC 104 | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312012102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4786337550 | ||||||||
| FaxNumber: | 4786333235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2011 | ||||||||
| LastUpdateDate: | 04/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 072547 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 282N00000X | N | Hospitals | General Acute Care Hospital |
No ID Information.