Provider Demographics
NPI:1720189285
Name:GLENN R PARRIS, MD PC
Entity type:Organization
Organization Name:GLENN R PARRIS, MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-962-1616
Mailing Address - Street 1:PO BOX 1519
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30048-1519
Mailing Address - Country:US
Mailing Address - Phone:770-962-1616
Mailing Address - Fax:770-962-9986
Practice Address - Street 1:4850 SUGARLOAF PKWY STE 501
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-2864
Practice Address - Country:US
Practice Address - Phone:770-962-1616
Practice Address - Fax:770-962-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031646174400000X
332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty