Healthcare Provider Details

I. General information

NPI: 1255397147
Provider Name (Legal Business Name): JEFFERY DEAN PARSON C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 JOHN ORR DRIVE
TIFTON GA
31794-3640
US

IV. Provider business mailing address

1619 JOHN ORR DR
TIFTON GA
31794-3640
US

V. Phone/Fax

Practice location:
  • Phone: 229-386-9829
  • Fax: 229-386-9830
Mailing address:
  • Phone: 229-386-9829
  • Fax: 229-386-9830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number1415
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: