Provider Demographics
NPI:1376742064
Name:PARKER, MARCIA LOUISE (DMD, MPH)
Entity Type:Individual
Prefix:MISS
First Name:MARCIA
Middle Name:LOUISE
Last Name:PARKER
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 IVAN ALLEN JR BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30313-1949
Mailing Address - Country:US
Mailing Address - Phone:404-523-6571
Mailing Address - Fax:404-523-6574
Practice Address - Street 1:239 IVAN ALLEN JR BLVD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30313-1949
Practice Address - Country:US
Practice Address - Phone:404-523-6571
Practice Address - Fax:404-523-6574
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011935122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00809278AMedicaid