Individual
LORETTA ANN PARHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1061 HARMON AVE, STE 1D03, FORT STEWART, GA 31314-5641
(912) 507-4492
Mailing address
1061 HARMON AVE, STE 1D03, FORT STEWART, GA 31314-5641
(912) 507-4492
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004410
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
264954116A
—
GA
05
—
264954116B
—
GA
Enumeration date
05/04/2006
Last updated
08/03/2012
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