Healthcare Provider Details

I. General information

NPI: 1568426567
Provider Name (Legal Business Name): MICHAEL E PARKER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S PARK ST
HOHENWALD TN
38462-1413
US

IV. Provider business mailing address

PO BOX 5
HOHENWALD TN
38462-0005
US

V. Phone/Fax

Practice location:
  • Phone: 931-796-7960
  • Fax: 931-796-7790
Mailing address:
  • Phone: 931-796-7960
  • Fax: 931-796-7790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0000000781
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: