Provider Demographics
NPI:1376606327
Name:PARRISH, WENDY (NP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:PARRISH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:886 HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6514
Mailing Address - Country:US
Mailing Address - Phone:678-583-8388
Mailing Address - Fax:678-583-8389
Practice Address - Street 1:886 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6514
Practice Address - Country:US
Practice Address - Phone:678-583-8388
Practice Address - Fax:678-583-8389
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR113642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA902870809AMedicaid
GA511I500547Medicare UPIN