MEDICARE: SEAN PARKER SA-C

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	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1841970571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN PARKER SA-C

Provider Business Mailing Address
First Line	:	2086 JODECO RD # 1251
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-5220
Country	:	US
Telephone Number	:	980-254-2256
Fax Number	:

Provider Business Practice Location Address
First Line	:	2086 JODECO RD # 1251
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-5220
Country	:	US
Telephone Number	:	980-254-2256
Fax Number	:

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

Provider Enumeration Date	:	07/18/2023
Last Update Date	:	01/18/2024

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Directions to “ SEAN PARKER SA-C” Practice Location

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