Provider Demographics
NPI:1073946117
Name:ANDERSON-PARRIS, MARY ANN (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:ANDERSON-PARRIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 4TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-2925
Mailing Address - Country:US
Mailing Address - Phone:229-377-0502
Mailing Address - Fax:
Practice Address - Street 1:3015 VETERANS PKWY S
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31788-6705
Practice Address - Country:US
Practice Address - Phone:229-985-4815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN122052363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health