Healthcare Provider Details

I. General information

NPI: 1407027642
Provider Name (Legal Business Name): AMIE PARKS ANDERSON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2008
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 SALEM RD
COVINGTON GA
30016-4527
US

IV. Provider business mailing address

115 MELROSE CREEK DR
STOCKBRIDGE GA
30281-2351
US

V. Phone/Fax

Practice location:
  • Phone: 678-342-6050
  • Fax: 678-342-6052
Mailing address:
  • Phone: 770-507-0325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH017279
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: