Provider Demographics
NPI:1346366549
Name:PARKINSON, EVADNE D (PT)
Entity Type:Individual
Prefix:
First Name:EVADNE
Middle Name:D
Last Name:PARKINSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TRADEPORT BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30354-2910
Mailing Address - Country:US
Mailing Address - Phone:404-968-0125
Mailing Address - Fax:
Practice Address - Street 1:3580 ATLANTA AVE
Practice Address - Street 2:
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-1706
Practice Address - Country:US
Practice Address - Phone:404-768-3351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist