1831168079 NPI number — CAROLE LYNETTE PARRISH NP-C

Table of content: CAROLE LYNETTE PARRISH NP-C (NPI 1831168079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831168079 NPI number — CAROLE LYNETTE PARRISH NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARRISH
Provider First Name:
CAROLE
Provider Middle Name:
LYNETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ABERNATHY
Provider Other First Name:
CAROLE
Provider Other Middle Name:
LYNETTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831168079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 743070
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:
30374-3070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-560-4304
Provider Business Mailing Address Fax Number:
864-560-4413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1075 TOWN CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32763-8360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-917-0333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2006

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: 208G00000X , with the licence number:  APN 2663 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LC0200X , with the licence number: 11006033 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 196544 . This is a "MEDCOST" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 0597L . This is a "BLUE CROSS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: NP1048 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7004029 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA10165019 . This is a "MEDICARE PIN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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