Loretta Ann Parham, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

004410 Issued in GA

Practice address

1061 Harmon Ave
Ste 1D03
Fort Stewart, GA 31314-5641

Phone

(912) 507-4492

NPI assigned

May 4, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Advanced Pediatric Specialists LLC

  • Pediatrics Physician
  • Savannah, GA
  • NPI 1073046397
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343952000000",
    "number": "1104874981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1061 HARMON AVE",
            "address_2": "STE 1D03",
            "city": "FORT STEWART",
            "state": "GA",
            "postal_code": "313145641",
            "telephone_number": "912-507-4492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1061 HARMON AVE",
            "address_2": "STE 1D03",
            "city": "FORT STEWART",
            "state": "GA",
            "postal_code": "313145641",
            "telephone_number": "912-507-4492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARHAM",
        "first_name": "LORETTA",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-04",
        "last_updated": "2012-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "004410",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "264954116B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "264954116A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joel Henry Page III, PHARMACIST
• Floreyce Ann Palmer, ARNP
• Jonathan Alan Palmer, CRNA
• Ramona L. Panther, LPN
• Jacob Papenfuss, PT
• Kendra Parker-Pitts, MD
• Jennifer Anne Parker, R.N.
• Christopher Parks
• Randolph W Parks, PHD PSYD
• Christopher H. Parnell, MD

• Medical Physician Assistant in Fort Stewart, GA
• Providers in Fort Stewart, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.