Healthcare Provider Details

I. General information

NPI: 1649261124
Provider Name (Legal Business Name): ELLEN ELIZABETH PARKER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST BB7514
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

1120 15TH ST BB7514
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2828
  • Fax: 706-721-6830
Mailing address:
  • Phone: 706-721-2828
  • Fax: 706-721-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: