Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 031089 | GA |
NPI | 1588751754 |
---|---|
Provider Name | Dr. Paul Mackie Parker |
First Address | Atlanta, GA 30345-3316 |
Second Address | Atlanta, GA 30345-3316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 29/07/2011 |