Provider Demographics
NPI:1700883311
Name:PARKERSON, JAMES L (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:PARKERSON
Suffix:
Gender:M
Credentials:OD
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 969
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-0969
Mailing Address - Country:US
Mailing Address - Phone:478-374-7473
Mailing Address - Fax:478-374-1500
Practice Address - Street 1:724 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6736
Practice Address - Country:US
Practice Address - Phone:478-374-7473
Practice Address - Fax:478-374-1500
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-29
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000839152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000134516CMedicaid
GA000134516CMedicaid
GA4472310001Medicare NSC