Basic Information
Provider Information | |||||||||
NPI: | 1578907812 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PARKER | ||||||||
FirstName: | SHELIA | ||||||||
MiddleName: | ANNETTE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 415 N JACKSON ST | ||||||||
Address2: | PO DRAWER 1348 | ||||||||
City: | AMERICUS | ||||||||
State: | GA | ||||||||
PostalCode: | 317093015 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2299312470 | ||||||||
FaxNumber: | 2299312474 | ||||||||
Practice Location | |||||||||
Address1: | 415 N JACKSON ST | ||||||||
Address2: |   | ||||||||
City: | AMERICUS | ||||||||
State: | GA | ||||||||
PostalCode: | 317093015 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2299312504 | ||||||||
FaxNumber: | 2299312471 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/17/2013 | ||||||||
LastUpdateDate: | 04/17/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 183647 | GA | Y |   | Nursing Service Providers | Registered Nurse |   |
No ID Information.