MEDICARE: DR. PAUL MACKIE 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	2086S0120X	Pediatric Surgery Physician	031089	GA

General Provider Information

NPI Number	:	1588751754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL MACKIE PARKER MD

Provider Business Mailing Address
First Line	:	1975 CENTURY BLVD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-3316
Country	:	US
Telephone Number	:	404-982-9938
Fax Number	:	404-982-9136

Provider Business Practice Location Address
First Line	:	1975 CENTURY BLVD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-3316
Country	:	US
Telephone Number	:	404-982-9938
Fax Number	:	404-982-9136

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/29/2011

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