Kathryn Parker

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

83384 Issued in GA

Practice address

470 Northside Cherokee Blvd Ste 230
Canton, GA 30115-8015

Phone

(770) 721-9460

Fax

(770) 721-9461

NPI assigned

Apr 10, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Northside Surgical Professional Services LLC

  • Surgery Physician
  • Atlanta, GA
  • NPI 1356630990
  Medicare reassignment NPD

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

{
    "created_epoch": "1334016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1417213893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 S GREENE ST # S4C12",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 NORTHSIDE CHEROKEE BLVD STE 230",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301158015",
            "telephone_number": "770-721-9460",
            "fax_number": "770-721-9461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKER",
        "first_name": "KATHRYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-10",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "83384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "NSCSG@Northside.gwaydirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "470 Northside Cherokee Blvd Ste 230",
            "city": "Canton",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301158015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jessica Ann Parada, DC
• Vittorio Paradiso, PHARMD
• Bonnie Ann Parent, APRN
• Annie Park, D.O.
• Brett Holland Parker
• Parkway Medical Equipment, Inc.
• Amy Jennifer Parnell
• Paros Medical LLC
• Casie Danielle Parris
• Majesty Malik Parson, M.A, RBT

• Surgery Physician in Canton, GA
• Providers in Canton, GA by specialty
• Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.