1386155612 NPI number — ANGELA ROSEA PARKER APRN, FNP-C

Table of content: ANGELA ROSEA PARKER APRN, FNP-C (NPI 1386155612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386155612 NPI number — ANGELA ROSEA PARKER APRN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
ANGELA
Provider Middle Name:
ROSEA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARKER
Provider Other First Name:
ANGELA
Provider Other Middle Name:
ROSEA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN. FNP-C
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1386155612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5665 NEW NORTHSIDE DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30328-4617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5520 HILLTOP PASS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRBURN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30213-7938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-732-3202
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN241015 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com