Individual provider Active NPI

Trudy-Ann Nicole Frazer, DDS

  • Pediatric Dentistry
  • Douglasville, GA
National Provider Identifier
1043655038
Registry record updated Apr 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DN014971 Issued in GA
Practice address
4020 Chapel Hill Rd
Douglasville, GA 30135-2829
Phone
(770) 949-2400
NPI assigned
May 3, 2013
Last updated
Apr 20, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X DN014971 GA Primary

Addresses

Primary practice location

4020 Chapel Hill Rd
Douglasville, GA 30135-2829

Mailing address

4020 Chapel Hill Rd
Douglasville, GA 30135-2829
Phone (770) 949-2400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161021002193 GA Order and Referring Only - Other (Non-Physician) 9537447743

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
R & R Dental Specialists, PC Pediatric Dentistry PastSince Jun 27, 2021 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461110400000",
    "number": "1043655038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4020 CHAPEL HILL RD",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301352829",
            "telephone_number": "770-949-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 CHAPEL HILL RD",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301352829",
            "telephone_number": "770-949-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRAZER",
        "first_name": "TRUDY-ANN",
        "middle_name": "NICOLE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-03",
        "last_updated": "2016-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN014971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglasville, GA

Sources for this page

Verify at the official NPI Registry.