Provider Demographics
NPI:1861481400
Name:PARRISH, CHARLES CLIFF (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CLIFF
Last Name:PARRISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 N DECATUR RD
Mailing Address - Street 2:SUITE 550
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6149
Mailing Address - Country:US
Mailing Address - Phone:404-296-1986
Mailing Address - Fax:404-296-9890
Practice Address - Street 1:2665 N DECATUR RD
Practice Address - Street 2:SUITE 550
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6149
Practice Address - Country:US
Practice Address - Phone:404-296-1986
Practice Address - Fax:404-296-9890
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034434174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000462734AMedicaid
GAE86268Medicare UPIN
GA10BBBFJMedicare ID - Type Unspecified