Provider Demographics
NPI:1891965281
Name:PARKER, STACEY ANN (MD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ANN
Last Name:PARKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4791 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-5324
Mailing Address - Country:US
Mailing Address - Phone:770-422-1400
Mailing Address - Fax:678-290-6728
Practice Address - Street 1:4791 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5324
Practice Address - Country:US
Practice Address - Phone:770-422-1400
Practice Address - Fax:678-290-6728
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060022207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA060022OtherLICENSE
GA120103132AMedicaid