MEDICARE: CHRISTIE ELLEN PARKER NP

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	363LG0600X	Gerontology Nurse Practitioner	RN187304	GA

General Provider Information

NPI Number	:	1730664582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIE ELLEN PARKER NP

Provider Business Mailing Address
First Line	:	310 KENNESTONE HOSPITAL BLVD
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-1120
Country	:	US
Telephone Number	:	770-793-7899
Fax Number	:	770-793-7856

Provider Business Practice Location Address
First Line	:	4630 JOHNSON FERRY PLACE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-2063
Country	:	US
Telephone Number	:	770-971-5870
Fax Number	:

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

Provider Enumeration Date	:	09/27/2018
Last Update Date	:	06/08/2021

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