Provider Demographics
NPI:1255397147
Name:PARSON, JEFFERY DEAN (CO)
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:DEAN
Last Name:PARSON
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 JOHN ORR DR
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-3640
Mailing Address - Country:US
Mailing Address - Phone:229-386-9829
Mailing Address - Fax:229-386-9830
Practice Address - Street 1:1619 JOHN ORR DRIVE
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3640
Practice Address - Country:US
Practice Address - Phone:229-386-9829
Practice Address - Fax:229-386-9830
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1415225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5633920001Medicare NSC