Provider Demographics
NPI:1720189285
Name:GLENN R PARRIS, MD PC
Entity Type:Organization
Organization Name:GLENN R PARRIS, MD PC
Other - Org Name:PARRIS & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-962-1616
Mailing Address - Street 1:PO BOX 1519
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30048-1519
Mailing Address - Country:US
Mailing Address - Phone:770-962-1616
Mailing Address - Fax:770-962-9986
Practice Address - Street 1:989 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-4702
Practice Address - Country:US
Practice Address - Phone:770-962-1616
Practice Address - Fax:770-962-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031646174400000X
332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty