Provider Demographics
NPI:1508004037
Name:PARKER, SANDRA ANN
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ANN
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 SIX OAKS CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-4782
Mailing Address - Country:US
Mailing Address - Phone:404-849-0392
Mailing Address - Fax:
Practice Address - Street 1:3604 SIX OAKS CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-4782
Practice Address - Country:US
Practice Address - Phone:404-849-0392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor