| Doctor Name: | WENDY FRAGOSO |
| NPI Number: | 1043423510 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | 011225 |
| Business Practice Address: | 1235 Indian Trail Rd Norcross, GA - 300935524 |
| Business Phone Number: | 7709311333 |
| Business Fax Number: | 7709313111 |
| Mailing Address: | 3829 Clearbrooke Way, DULUTH |
| State: | GA |
| Postal Code: | 300977324 |
| Phone Number: | 9144098830 |
| Fax Number: | |
| NPI Enumeration Date: | 05/08/2007 |
| NPI Last Update Date: | 07/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 011225 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |