Provider Demographics
NPI:1295819811
Name:PARKER, SEAN P (PA-C)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:P
Last Name:PARKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 W GORDON ST STE B
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-3427
Mailing Address - Country:US
Mailing Address - Phone:706-647-7009
Mailing Address - Fax:706-647-7014
Practice Address - Street 1:915 W GORDON ST STE B
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3427
Practice Address - Country:US
Practice Address - Phone:706-647-7009
Practice Address - Fax:706-647-7014
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003803363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100001646DMedicaid
GA100001646AMedicaid
GA100001646CMedicaid
GA100001646BMedicaid