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NPI Code Detail

MEDICARE: GLENN R PARRIS, MD PC

MEDICARE: GLENN R PARRIS, MD PC
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
1332900000XNon-Pharmacy Dispensing Site
2174400000XSpecialist031646GA

General Provider Information

NPI Number : 1720189285
Entity Type Code : Organization
Provider Name (Legal Business Name) : GLENN R PARRIS, MD PC
Provider Business Mailing Address
First Line : PO BOX 1519
Second Line :
City : LILBURN
State : GA
Zip : 30048-1519
Country : US
Telephone Number : 770-962-1616
Fax Number : 770-962-9986
Provider Business Practice Location Address
First Line : 4850 SUGARLOAF PKWY STE 501
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30044-2864
Country : US
Telephone Number : 770-962-1616
Fax Number : 770-962-7977
Authorized Official
Title or Position : PRESIDENT/CEO
Name : GLENN R PARRIS
Credential : MD
Telephone Number : 770-962-1616
Provider Enumeration Date : 09/26/2006
Last Update Date : 09/24/2024

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