=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700612389
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA MARIE PARRISH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2024
-----------------------------------------------------
Last Update Date | 09/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4645 BATTLEFIELD PKWY
-----------------------------------------------------
City | RINGGOLD
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30736-8011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-648-2362
-----------------------------------------------------
Fax | 423-648-9294
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2004 HAYES ST STE 800
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37203-2659
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-329-0570
-----------------------------------------------------
Fax | 615-329-0579
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 36595
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------