Provider Demographics
NPI:1477607489
Name:PARKER, LILLIAN GRACE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:GRACE
Last Name:PARKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:DAVENPORT
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, PHD
Mailing Address - Street 1:3629 WINDMILL RD
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-2106
Mailing Address - Country:US
Mailing Address - Phone:770-987-1881
Mailing Address - Fax:
Practice Address - Street 1:3629 WINDMILL RD
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-2106
Practice Address - Country:US
Practice Address - Phone:770-987-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN052630364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health