Provider Demographics
NPI:1912123183
Name:PARRIS, STEPHANIE DELPHINE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DELPHINE
Last Name:PARRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 PEMBRIDGE TRCE NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-5471
Mailing Address - Country:US
Mailing Address - Phone:770-627-2675
Mailing Address - Fax:
Practice Address - Street 1:2603 OSBORNE RD STE E
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-8907
Practice Address - Country:US
Practice Address - Phone:770-627-2675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004454363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA004454OtherPHYSICIAN ASSISTANT LICEN