Healthcare Provider Details

I. General information

NPI: 1396772885
Provider Name (Legal Business Name): LUCY PARLOR RN,C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 CLAIRMONT RD # 11B-CHN
DECATUR GA
30033
US

IV. Provider business mailing address

400 FAIRBURN RD SW # L-92 P.O BOX 310175
ATLANTA GA
30331
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax: 404-728-5029
Mailing address:
  • Phone: 404-321-6111
  • Fax: 404-728-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number041089
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: