Provider Demographics
NPI:1336298264
Name:LILLIAN DAVENPORT PARKER
Entity Type:Organization
Organization Name:LILLIAN DAVENPORT PARKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NURSE SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:CNSPMH
Authorized Official - Phone:770-987-1881
Mailing Address - Street 1:3629 WINDMILL RD
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-2106
Mailing Address - Country:US
Mailing Address - Phone:770-987-1881
Mailing Address - Fax:
Practice Address - Street 1:3629 WINDMILL RD
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-2106
Practice Address - Country:US
Practice Address - Phone:770-987-1881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN052630 CNSPMH364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty