Provider Demographics
NPI:1679173496
Name:PARKERSON, JULIE ROGERS
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ROGERS
Last Name:PARKERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2078 KILBIRNIE CT NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-8274
Mailing Address - Country:US
Mailing Address - Phone:678-231-8807
Mailing Address - Fax:
Practice Address - Street 1:150 COBB PKWY S
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-9209
Practice Address - Country:US
Practice Address - Phone:678-285-0242
Practice Address - Fax:678-285-0244
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist