Healthcare Provider Details

I. General information

NPI: 1962470385
Provider Name (Legal Business Name): JONATHAN R PARROTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 NORTHWOOD PARK DR
VALDOSTA GA
31602-1392
US

IV. Provider business mailing address

PO BOX 3225
VALDOSTA GA
31604-3225
US

V. Phone/Fax

Practice location:
  • Phone: 229-249-7888
  • Fax: 229-241-7810
Mailing address:
  • Phone: 229-249-7888
  • Fax: 229-241-7810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number36246
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: