Provider Demographics
NPI:1841675519
Name:PARRIS, KEN
Entity type:Individual
Prefix:
First Name:KEN
Middle Name:
Last Name:PARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 ALPS RD UNIT 5276
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-0111
Mailing Address - Country:US
Mailing Address - Phone:404-790-1986
Mailing Address - Fax:
Practice Address - Street 1:196 ALPS RD UNIT 5276
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30604-0111
Practice Address - Country:US
Practice Address - Phone:404-790-1986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer