Provider Demographics
NPI:1912138116
Name:PARROTT MEDICAL CLINIC PC
Entity Type:Organization
Organization Name:PARROTT MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PARROTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-249-7888
Mailing Address - Street 1:PO BOX 3225
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31604-3225
Mailing Address - Country:US
Mailing Address - Phone:229-249-7888
Mailing Address - Fax:229-241-7810
Practice Address - Street 1:804 NORTHWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1392
Practice Address - Country:US
Practice Address - Phone:229-249-7888
Practice Address - Fax:229-241-7810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty