Provider Demographics
NPI:1548728454
Name:PARKER, CHARLES JEFFERY SR
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:JEFFERY
Last Name:PARKER
Suffix:SR
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 1:240 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-6130
Mailing Address - Country:US
Mailing Address - Phone:318-209-0383
Mailing Address - Fax:
Practice Address - Street 1:240 MILLER RD
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-6130
Practice Address - Country:US
Practice Address - Phone:318-209-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-10
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver