MEDICARE: DR. MARTHA (MOLLY) KEETON PARNELL PHD

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	103TC1900X	Counseling Psychologist	PSY 002746	GA

General Provider Information

NPI Number	:	1285723098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA (MOLLY) KEETON PARNELL PHD

Provider Business Mailing Address
First Line	:	1945 MASON MILL RD
Second Line	:	SUITE 100
City	:	DECATUR
State	:	GA
Zip	:	30033-4006
Country	:	US
Telephone Number	:	404-215-4035
Fax Number	:	404-321-4887

Provider Business Practice Location Address
First Line	:	1945 MASON MILL RD
Second Line	:	SUITE 100
City	:	DECATUR
State	:	GA
Zip	:	30033-4006
Country	:	US
Telephone Number	:	404-215-4035
Fax Number	:	404-321-4887

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	09/16/2011

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