Healthcare Provider Details

I. General information

NPI: 1932552890
Provider Name (Legal Business Name): LISA MARIE PARKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321A INTERSTATE PKWY
AUGUSTA GA
30909-5626
US

IV. Provider business mailing address

1 HICKMAN ST
GRANITEVILLE SC
29829-2955
US

V. Phone/Fax

Practice location:
  • Phone: 706-738-7246
  • Fax: 706-738-7248
Mailing address:
  • Phone: 803-392-7092
  • Fax: 803-392-7174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN201619
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20218
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: