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General NPI Number Information
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NPI Number | 1609511740
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Entity Type | Individual
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Provider Name | JACOB ROY PARKER DO
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Gender | Male
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Dates
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Enumeration Date | 05/03/2022
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 1168 N MAIN ST STE 110
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City | CEDARTOWN
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State | GA
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Zip | 30125-2039
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Country | US
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Telephone | 770-749-1005
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Fax | 770-749-1119
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Provider Business Mailing Address
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Address Line | PO BOX 12938 C/O CLINIC MANAGEMENT
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City | CALHOUN
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State | GA
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Zip | 30703
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Country | US
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Telephone | 706-602-7800
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L.5754R
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 105337
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License Number State | GA
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