Provider Demographics
NPI:1275347601
Name:PARKER, GAVIN
Entity type:Individual
Prefix:
First Name:GAVIN
Middle Name:
Last Name:PARKER
Suffix:
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 1:9407 PEPPERIDGE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-3524
Mailing Address - Country:US
Mailing Address - Phone:330-475-2290
Mailing Address - Fax:
Practice Address - Street 1:1502 BRITTAIN RD # 1149
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3605
Practice Address - Country:US
Practice Address - Phone:330-475-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide