Healthcare Provider Details

I. General information

NPI: 1861896979
Provider Name (Legal Business Name): MATTHEW PARSONS PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 N POND ST
TOCCOA GA
30577-1920
US

IV. Provider business mailing address

377 N POND ST
TOCCOA GA
30577-1920
US

V. Phone/Fax

Practice location:
  • Phone: 706-886-7787
  • Fax:
Mailing address:
  • Phone: 706-886-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH019247
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: