1326165705 NPI number — BARRY N PARKER PA-C

Table of content: BARRY N PARKER PA-C (NPI 1326165705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326165705 NPI number — BARRY N PARKER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
BARRY
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326165705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5080 SPECTRUM DR
Provider Second Line Business Mailing Address:
SUITE 1200 W
Provider Business Mailing Address City Name:
ADDISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75001-4648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-725-6673
Provider Business Mailing Address Fax Number:
214-775-4406

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
755 LAWRENCEVILLE SUWANEE RD
Provider Second Line Business Practice Location Address:
STE 1600
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30043-7346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-995-1500
Provider Business Practice Location Address Fax Number:
214-775-4502
Provider Enumeration Date:
03/23/2007

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: 363A00000X , with the licence number:  2231 , 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)





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