Healthcare Provider Details

I. General information

NPI: 1982924262
Provider Name (Legal Business Name): JOHN H PARKER V MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 ELM ST
CUMMING GA
30040-2467
US

IV. Provider business mailing address

PO BOX 307
CUMMING GA
30028-0307
US

V. Phone/Fax

Practice location:
  • Phone: 770-887-1668
  • Fax: 678-807-1020
Mailing address:
  • Phone: 770-887-1668
  • Fax: 678-807-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: