Provider Demographics
NPI:1851455133
Name:PARKER, PERMELIA ANN (CSA)
Entity Type:Individual
Prefix:MRS
First Name:PERMELIA
Middle Name:ANN
Last Name:PARKER
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:GA
Mailing Address - Zip Code:31302-0471
Mailing Address - Country:US
Mailing Address - Phone:912-728-6753
Mailing Address - Fax:
Practice Address - Street 1:2359 NOEL C CONAWAY RD
Practice Address - Street 2:
Practice Address - City:GUYTON
Practice Address - State:GA
Practice Address - Zip Code:31312-6114
Practice Address - Country:US
Practice Address - Phone:912-728-6753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA04-228174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist