WENDY FRAGOSO (NPI# 1043423510) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043423510 |
| Entity Type | Individual |
| Full Name | WENDY FRAGOSO |
| Credential | PA |
| Practice Address |
1003 Oak Rd Sw Ste B Lilburn GA 30047-1826 |
| Mailing Address |
1003 Oak Rd Sw Lilburn GA 30047-1826 |
| Practice Telephone | 4708858080 |
| Practice Fax Number | 4708858088 |
| Mailing Telephone | 4708858080 |
| Mailing Fax Number | 4708858088 |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2020-08-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
6387 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1003 OAK RD SW STE B |
| City | LILBURN |
| State | GA |
| Zip Code | 30047-1826 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720698426 | Open Hands Medical Center, LLC | Family Medicine | 1003 Oak Rd Sw Ste B, Lilburn, GA 30047-1826 | 2020-08-06 |
| 1922358027 | Stacey Lorriane Fears | Nurse Practitioner | 1003 Oak Rd Sw Ste B, Lilburn, GA 30047-1826 | 2012-09-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750861217 | Latrina S Walden | Nurse Practitioner | 887 Ryan Lane, Lilburn, GA 30047 | 2018-08-15 |
| 1811483928 | Olivia Oyegunle | Optometrist | 4153 Lawrenceville Hwy Nw Ste 5, Lilburn, GA 30047 | 2018-07-02 |
| 1932619285 | Mpm Creative, LLC | Speech-Language Pathologist | 1560 Hewatt Rd, Lilburn, GA 30047 | 2017-10-01 |
| 1528515186 | Smith Dental Care of Lilburn, Inc. | Dentist | 3100 Five Forks Trickham Rd Suite 201, Lilburn, GA 30047 | 2016-09-01 |
| 1891143244 | Choices Behavioral Alternatives | Counselor | 4037 Darling Court, Suite B, Lilburn, GA 30047 | 2016-05-26 |
| 1235595687 | Georgia Dental Associates | Clinic/Center | 3100 Five Forks Trickum Road Suite 201, Lilburn, GA 30047 | 2016-01-14 |
| 1912382144 | Sangeetha Asokan | Dentist | 609, Beaver Ruin Road, Tebo Dental for Kids, Lilburn, GA 30047 | 2015-07-29 |
| 1467836403 | Pamela Neal | Registered Nurse | 3315 Landingview Ct, Lilburn, GA 30047 | 2015-07-18 |
| 1699172452 | Josie Kou, Kulah Curran | Registered Nurse | 3708 Tamer Ln, Lilburn, GA 30047 | 2014-11-21 |
| 1184039380 | Cheryl Lee | Chiropractor | 5014 Stone Mountain Hwy, Suite C, Lilburn, GA 30047 | 2014-06-25 |
| Find all providers in zip 30047 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154417277 | Donald E Sally | Physician Assistant | 4030 Lawrenceville Hwy Nw, Lilburn, GA 30047-2823 | 2006-10-05 |
| 1093331886 | Sanya Nijhara | Physician Assistant | 4025 Lawrenceville Hwy Nw, Lilburn, GA 30047-3013 | 2020-06-17 |
| 1861547168 | Katherine Jane Purdy | Physician Assistant | 354 Arcado Rd Nw, Lilburn, GA 30047-2815 | 2007-01-24 |
| 1538211651 | Linda D Cox | Physician Assistant | 354 Arcado Rd Nw, Suite 1, Lilburn, GA 30047-2815 | 2007-01-17 |
| 1801958012 | Glenda Y Alvarez Tarnoff | Physician Assistant | 4030 Lawrenceville Hwy Nw, Ste. 9, Lilburn, GA 30047-2820 | 2006-12-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245838374 | Erica Elizabeth West | Physician Assistant | 1155 Mount Vernon Hwy Ste 101, Atlanta, GA 30338-5439 | 2020-10-12 |
| 1801402888 | Meredith Gaines | Physician Assistant | 603 W 1st St Unit 1, Rome, GA 30161-3067 | 2020-09-16 |
| 1770108805 | Kelsey Lynne Greeff | Physician Assistant | 3400 Old Milton Pkwy Ste C, Alpharetta, GA 30005-3707 | 2020-06-15 |
| 1518596733 | Rebecca Faye Tsyrlin | Physician Assistant | 2655 Dallas Hwy Sw Ste 340, Marietta, GA 30064-7518 | 2020-04-08 |
| 1487291878 | Ashley Cohen | Physician Assistant | 250 E Ponce De Leon Ave Ste 800, Decatur, GA 30030-3438 | 2019-12-04 |
| 1932757606 | Andrea J Holley | Physician Assistant | 1629 Austin Meadows Dr, Decatur, GA 30032-3888 | 2019-08-27 |
| 1265089759 | Alexis Chester Jones | Physician Assistant | 3000 Old Alabama Rd # 128, Johns Creek, GA 30022-5860 | 2019-08-20 |
| 1841851680 | Lauren Price Fogarty | Physician Assistant | 5445 Meridian Marks Rd Ste 430, Atlanta, GA 30342-4755 | 2019-06-24 |
| 1386208262 | Jessica A Drews | Physician Assistant | 2342 Cortez Way Ne, Brookhaven, GA 30319-3914 | 2019-04-26 |
| 1174187421 | Krisna Patel | Physician Assistant | 1805 Honey Creek Cmns Se Ste B, Conyers, GA 30013-5829 | 2019-04-23 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.