Individual
STACEY ANN PARKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4791 S MAIN ST, ACWORTH, GA 30101-5324
(770) 422-1400
(678) 290-6728
Mailing address
4791 S MAIN ST, ACWORTH, GA 30101-5324
(770) 422-1400
(678) 290-6728
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
060022
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060022
LICENSE
GA
05
—
120103132A
—
GA
Enumeration date
03/03/2008
Last updated
03/23/2012
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