Healthcare Provider Details

I. General information

NPI: 1881279149
Provider Name (Legal Business Name): RAQUEL DENISE PARKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 HIGHWAY 138 SW
RIVERDALE GA
30274-3965
US

IV. Provider business mailing address

1896 SCHOFIELD DR
HAMPTON GA
30228-3656
US

V. Phone/Fax

Practice location:
  • Phone: 678-855-6344
  • Fax: 678-855-6423
Mailing address:
  • Phone: 757-750-5547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP202348
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: