Provider Demographics
NPI:1689224974
Name:PARHAM, ANNELL
Entity Type:Individual
Prefix:
First Name:ANNELL
Middle Name:
Last Name:PARHAM
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 1:116 SPORTSMANS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-8747
Mailing Address - Country:US
Mailing Address - Phone:478-453-7062
Mailing Address - Fax:
Practice Address - Street 1:116 SPORTSMANS DRIVE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-8747
Practice Address - Country:US
Practice Address - Phone:478-453-7062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider