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NPI Code Detail

MEDICARE: EVADNE D PARKINSON PT

MEDICARE: EVADNE D PARKINSON PT
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
1225100000XPhysical TherapistPT002946GA

General Provider Information

NPI Number : 1346366549
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVADNE D PARKINSON PT
Provider Business Mailing Address
First Line : 200 TRADEPORT BLVD
Second Line : SUITE 211
City : ATLANTA
State : GA
Zip : 30354-2910
Country : US
Telephone Number : 404-968-0125
Fax Number :
Provider Business Practice Location Address
First Line : 3580 ATLANTA AVE
Second Line :
City : HAPEVILLE
State : GA
Zip : 30354-1706
Country : US
Telephone Number : 404-768-3351
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 06/19/2008

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