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NPI Code Detail

MEDICARE: DR. GLENN R PARRIS M.D.

MEDICARE: DR. GLENN R PARRIS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist031646GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417148834
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GLENN R PARRIS M.D.
Provider Business Mailing Address
First Line : 4850 SUGARLOAF PKWY STE 501
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30044-2864
Country : US
Telephone Number : 770-962-1616
Fax Number : 770-962-7977
Provider Business Practice Location Address
First Line : 4850 SUGARLOAF PKWY STE 501
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30044-2864
Country : US
Telephone Number : 770-962-1616
Fax Number : 770-962-7977
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2007
Last Update Date : 05/09/2023

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