Healthcare Provider Details

I. General information

NPI: 1548663644
Provider Name (Legal Business Name): PARKAIRE CONSULTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4939 LOWER ROSWELL RD SUITE 201C
MARIETTA GA
30068-4338
US

IV. Provider business mailing address

4939 LOWER ROSWELL RD SUITE 201C
MARIETTA GA
30068-4338
US

V. Phone/Fax

Practice location:
  • Phone: 770-578-1519
  • Fax: 770-578-0860
Mailing address:
  • Phone: 770-578-1519
  • Fax: 770-578-0860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateGA

VIII. Authorized Official

Name: SHERYL KESSLER PRUITT
Title or Position: CLINICAL DIRECTOR
Credential: M.ED/PT
Phone: 770-578-1519