Provider Demographics
NPI:1477502789
Name:PARKER-HERRIOTT, JAKELYN ANNETTE (OD)
Entity Type:Individual
Prefix:DR
First Name:JAKELYN
Middle Name:ANNETTE
Last Name:PARKER-HERRIOTT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16143
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2843
Mailing Address - Country:US
Mailing Address - Phone:912-927-0707
Mailing Address - Fax:912-927-0677
Practice Address - Street 1:321 W MONTGOMERY XRD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3392
Practice Address - Country:US
Practice Address - Phone:912-927-0707
Practice Address - Fax:912-927-0677
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001403152W00000X, 152WL0500X, 152WV0400X
SC1075152W00000X, 152WL0500X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADG1403Medicaid
GA00612092AMedicaid
GA41ZCCMGMedicare PIN
GADG1403Medicaid
GA00612092AMedicaid