Provider Demographics
NPI:1144488826
Name:FRAY, ALICE MERLE
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:MERLE
Last Name:FRAY
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 1:1155 LAVISTA RD
Mailing Address - Street 2:APT 1404
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324
Mailing Address - Country:US
Mailing Address - Phone:678-571-8795
Mailing Address - Fax:
Practice Address - Street 1:1155 LAVISTA RD
Practice Address - Street 2:APT 1404
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324
Practice Address - Country:US
Practice Address - Phone:678-571-8795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA66598207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine