Healthcare Provider Details

I. General information

NPI: 1649518432
Provider Name (Legal Business Name): WILEY A. PARKER, M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5669 PEACHTREE DUNWOODY RD NE SUITE 295
ATLANTA GA
30342-1786
US

IV. Provider business mailing address

5669 PEACHTREE DUNWOODY RD NE SUITE 295
ATLANTA GA
30342-1786
US

V. Phone/Fax

Practice location:
  • Phone: 404-256-9822
  • Fax: 404-256-0250
Mailing address:
  • Phone: 404-256-9822
  • Fax: 404-256-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. WILEY A PARKER
Title or Position: OWNER
Credential: MD
Phone: 404-256-9822