Provider Demographics
NPI:1275692576
Name:PARKER, DIANNE ALICE (RN)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:ALICE
Last Name:PARKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:ALICE
Other - Last Name:SPEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:250 NORTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601
Mailing Address - Country:US
Mailing Address - Phone:706-542-9739
Mailing Address - Fax:706-542-9693
Practice Address - Street 1:250 NORTH AVENUE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601
Practice Address - Country:US
Practice Address - Phone:706-542-9739
Practice Address - Fax:706-542-9693
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN138456101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health