Provider Demographics
NPI:1124099403
Name:PARKER, LORI A (DO)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:PARKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1170
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-1170
Mailing Address - Country:US
Mailing Address - Phone:470-325-0159
Mailing Address - Fax:470-325-0191
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:770-535-0191
Practice Address - Fax:770-535-0916
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051262207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA8940029OtherUNITED HEALTHCARE
GA000946701DMedicaid
GA10044700OtherAMERIGROUP
GA000946701CMedicaid
GA000946701BMedicaid
GA52893003OtherBCBS
GA7486156OtherAETNA
GA000946701EMedicaid
GA336359OtherWELLCARE
GA6755985OtherCIGNA
GAP00117237OtherRR MEDICARE-GRP # CC4177
GA52893003OtherBCBS
GAP00117237OtherRR MEDICARE-GRP # CC4177