Healthcare Provider Details

I. General information

NPI: 1245712777
Provider Name (Legal Business Name): LESA PARKER MS, ARPN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

772 MADDOX DR STE 122
EAST ELLIJAY GA
30540-8196
US

IV. Provider business mailing address

165 BLUE RIDGE OVERLOOK
BLUE RIDGE GA
30513-4431
US

V. Phone/Fax

Practice location:
  • Phone: 706-635-6898
  • Fax:
Mailing address:
  • Phone: 855-437-1557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN184483
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: