Provider Demographics
NPI:1538265491
Name:PARKER, JAMES A (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:PARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 LANGFORD DR BLDG 300-105
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7305
Mailing Address - Country:US
Mailing Address - Phone:706-543-0404
Mailing Address - Fax:706-549-0065
Practice Address - Street 1:1181 LANGFORD DR BLDG 300-105
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7305
Practice Address - Country:US
Practice Address - Phone:706-543-0404
Practice Address - Fax:706-549-0065
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045573208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000797475AMedicaid
GA000797475AMedicaid
F60509Medicare UPIN