MEDICARE: TIMOTHY RYAN PARKER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	LL82558	SC

General Provider Information

NPI Number	:	1063944429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY RYAN PARKER MD

Provider Business Mailing Address
First Line	:	701 GROVE ROAD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-5601
Country	:	US
Telephone Number	:	864-455-5777
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 GROVE ROAD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-5601
Country	:	US
Telephone Number	:	864-455-8988
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	10/19/2021

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