Provider Demographics
NPI:1346438454
Name:PARKER, ANDREW WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WAYNE
Last Name:PARKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 NEWNAN ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3429
Mailing Address - Country:US
Mailing Address - Phone:770-834-6669
Mailing Address - Fax:770-834-4814
Practice Address - Street 1:624 NEWNAN ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3429
Practice Address - Country:US
Practice Address - Phone:770-834-6669
Practice Address - Fax:770-834-4814
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor