Provider Demographics
NPI:1043302896
Name:PARKER, KATRINA L (MD)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:L
Last Name:PARKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:75 PIEDMONT AVE STE
Mailing Address - Street 2:STE 700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303
Mailing Address - Country:US
Mailing Address - Phone:404-756-1400
Mailing Address - Fax:404-756-1400
Practice Address - Street 1:35 JESSE HILL JR DRIVE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-785-9850
Practice Address - Fax:404-785-9828
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL78382080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163452901Medicaid
TXE38721Medicare UPIN
TX163452901Medicaid