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General NPI Number Information
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NPI Number | 1679583371
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Entity Type | Individual
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Provider Name | MARCUS L PARKER PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 3708 NORTHSIDE DRIVE
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City | MACON
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State | GA
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Zip | 31210
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Country | US
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Telephone | 478-745-4206
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Fax | 478-254-5324
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Provider Business Mailing Address
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Address Line | 102 LANCE DR
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City | MACON
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State | GA
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Zip | 31216-6170
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Country | US
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Telephone | 478-320-6923
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 004556
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License Number State | GA
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