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General NPI Number Information
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NPI Number | 1336298264
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Entity Type | Organization
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Legal Business Name | LILLIAN DAVENPORT PARKER
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 3629 WINDMILL RD
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City | ELLENWOOD
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State | GA
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Zip | 30294-2106
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Country | US
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Telephone | 770-987-1881
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Fax |
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Provider Business Mailing Address
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Address Line | 3629 WINDMILL RD
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City | ELLENWOOD
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State | GA
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Zip | 30294-2106
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Country | US
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Telephone | 770-987-1881
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Fax |
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Authorized Official
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Title or Position | CLINICAL NURSE SPECIALIST
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Name | MS. LILLIAN GRACE PARKER
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Credential | CNSPMH
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Telephone | 770-987-1881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | RN052630 CNSPMH
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License Number State | GA
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