Organization Name: | FIRST COAST ENT |
NPI Number: | 1346427143 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN TEMPLE FRAKER (MD/OWNER) |
Mailing Address: | 2040 Dan Proctor Dr Suite 250 Saint Marys |
State: | GA US |
Postal Code: | 315583811 |
Phone Number: | 9127292794 |
Fax Number: | 9127294469 |
NPI Enumeration Date: | 01/24/2008 |
NPI Last Update Date: | 01/24/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 056552 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |