Healthcare Provider Details

I. General information

NPI: 1922114974
Provider Name (Legal Business Name): SAREETA S. PARKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 01/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 MOUNT ZION PKWY KAISER PERMANENTE SOUTHWOOD SPECIALTY CENTER
JONESBORO GA
30236-2500
US

IV. Provider business mailing address

3495 PIEDMONT RD NE NINE PIEDMONT CENTER
ATLANTA GA
30305-1717
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-5225
  • Fax: 404-778-3337
Mailing address:
  • Phone: 404-364-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number042437
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number42437
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number42437
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: