Provider Demographics
NPI:1225679921
Name:PARRISH, JACQUELINE PICKETT (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:PICKETT
Last Name:PARRISH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 WILLOW TREE TRCE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-3842
Mailing Address - Country:US
Mailing Address - Phone:404-665-6427
Mailing Address - Fax:404-241-9269
Practice Address - Street 1:3511 WILLOW TREE TRCE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-3842
Practice Address - Country:US
Practice Address - Phone:404-665-6427
Practice Address - Fax:404-241-9269
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN107092261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health