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General NPI Number Information
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NPI Number | 1043288459
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Entity Type | Individual
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Provider Name | ROBERTA JEAN PARKER DPM
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Gender | Female
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Dates
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Enumeration Date | 03/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 730 WEST LANIER AVENUE
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City | FAYETTEVILLE
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State | GA
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Zip | 30214
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Country | US
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Telephone | 770-460-5064
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Fax | 770-460-0838
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Provider Business Mailing Address
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Address Line | 730 WEST LANIER AVENUE
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City | FAYETTEVILLE
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State | GA
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Zip | 30214
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Country | US
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Telephone | 770-460-5064
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Fax | 770-460-0838
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | GA000588
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License Number State | GA
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