Provider Demographics
NPI:1699933713
Name:RICHARD L PARKER SR LLC
Entity type:Organization
Organization Name:RICHARD L PARKER SR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LANCE
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:SR
Authorized Official - Credentials:COF
Authorized Official - Phone:770-414-4260
Mailing Address - Street 1:1479 BROCKETT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7326
Mailing Address - Country:US
Mailing Address - Phone:770-414-4260
Mailing Address - Fax:770-414-4257
Practice Address - Street 1:1479 BROCKETT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7326
Practice Address - Country:US
Practice Address - Phone:770-414-4260
Practice Address - Fax:770-414-4257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies