Provider Demographics
NPI:1356649891
Name:PARSONS, ANITA SIMS (R PH)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:SIMS
Last Name:PARSONS
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 MALLARD CIR
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-2763
Mailing Address - Country:US
Mailing Address - Phone:706-202-4740
Mailing Address - Fax:706-635-2246
Practice Address - Street 1:312 S BROAD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2106
Practice Address - Country:US
Practice Address - Phone:706-752-1553
Practice Address - Fax:770-267-2778
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH013355183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH013355OtherPHARMACIST LISCENSE