MEDICARE: MS. GINA W PARRIS EDS MSW LMFT

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
1	106H00000X	Marriage & Family Therapist	000719	GA

General Provider Information

NPI Number	:	1619958865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GINA W PARRIS EDS MSW LMFT

Provider Business Mailing Address
First Line	:	3383 WOLF DR
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30506-1439
Country	:	US
Telephone Number	:	770-841-2926
Fax Number	:	678-985-5393

Provider Business Practice Location Address
First Line	:	3383 WOLF DR
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30506-1439
Country	:	US
Telephone Number	:	770-841-2926
Fax Number	:	770-874-9083

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	01/05/2021

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