Healthcare Provider Details

I. General information

NPI: 1922003904
Provider Name (Legal Business Name): THOMAS B PARROTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1192 ROCKBRIDGE RD STE A
STONE MOUNTAIN GA
30087-2923
US

IV. Provider business mailing address

1192 ROCKBRIDGE RD STE A
STONE MOUNTAIN GA
30087-2923
US

V. Phone/Fax

Practice location:
  • Phone: 770-925-2010
  • Fax: 770-925-1665
Mailing address:
  • Phone: 770-925-2010
  • Fax: 770-925-1665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number63514
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: