Provider Demographics
NPI:1871769455
Name:PARKER, PENNIE CHRISTIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:PENNIE
Middle Name:CHRISTIE
Last Name:PARKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-2416
Mailing Address - Country:US
Mailing Address - Phone:404-406-1384
Mailing Address - Fax:
Practice Address - Street 1:605 W GORDON ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3425
Practice Address - Country:US
Practice Address - Phone:706-646-6040
Practice Address - Fax:706-646-6039
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN47942164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse