Provider Demographics
NPI:1992813802
Name:PARKER, STACEY M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:M
Last Name:PARKER
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 1:605 POINTE NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-1514
Mailing Address - Country:US
Mailing Address - Phone:229-435-7161
Mailing Address - Fax:229-438-8588
Practice Address - Street 1:605 POINTE NORTH BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-1514
Practice Address - Country:US
Practice Address - Phone:229-435-7161
Practice Address - Fax:229-438-8588
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004411363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97WCGCWMedicare ID - Type Unspecified
GAQ30435Medicare UPIN