1225033103 NPI number — MRS. LILLIE BLAND PARRISH NP

Table of content: MRS. LILLIE BLAND PARRISH NP (NPI 1225033103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225033103 NPI number — MRS. LILLIE BLAND PARRISH NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARRISH
Provider First Name:
LILLIE
Provider Middle Name:
BLAND
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARRISH
Provider Other First Name:
LILLIE
Provider Other Middle Name:
MAE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
III
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225033103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2050 GREAT RIVER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30045-7014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-513-4183
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3650 STEVE REYNOLDS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30096-4506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-931-6107
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2005

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: 363LW0102X , with the licence number:  RN052558 , 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)