Provider Demographics
NPI:1063863447
Name:PARKS, CHANDRA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 HAMIL RD
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-6637
Mailing Address - Country:US
Mailing Address - Phone:678-357-5649
Mailing Address - Fax:
Practice Address - Street 1:520 HAMIL RD
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-6637
Practice Address - Country:US
Practice Address - Phone:678-357-5649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN134914163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse