Healthcare Provider Details

I. General information

NPI: 1942130034
Provider Name (Legal Business Name): PARKER ACTIVE RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 VETERANS MEMORIAL HWY SE
MABLETON GA
30126-2848
US

IV. Provider business mailing address

1251 SILVERCREST CT
POWDER SPRINGS GA
30127-6084
US

V. Phone/Fax

Practice location:
  • Phone: 770-560-5556
  • Fax:
Mailing address:
  • Phone: 770-560-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DWAYNE PARKER
Title or Position: OWNER
Credential:
Phone: 770-560-5556