Healthcare Provider Details

I. General information

NPI: 1083218341
Provider Name (Legal Business Name): PARKER WILSON PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2020
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 OLD PENDERGRASS RD
JEFFERSON GA
30549-2705
US

IV. Provider business mailing address

302 SMOKEY HOLLOW RD
JEFFERSON GA
30549-3566
US

V. Phone/Fax

Practice location:
  • Phone: 678-387-7620
  • Fax:
Mailing address:
  • Phone: 706-540-4512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH031332
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: