Provider Demographics
NPI:1780198820
Name:PARKS, JOANNE PATRICE (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:PATRICE
Last Name:PARKS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 HENDERSON WALK
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-4329
Mailing Address - Country:US
Mailing Address - Phone:770-828-9340
Mailing Address - Fax:
Practice Address - Street 1:3110 HENDERSON WALK
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30340-4329
Practice Address - Country:US
Practice Address - Phone:770-828-9340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN231761363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health