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NPI Code Detail

MEDICARE: ERIC TAEJIN PARK DO

MEDICARE: ERIC TAEJIN PARK DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramGA

General Provider Information

NPI Number : 1710828983
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC TAEJIN PARK DO
Provider Business Mailing Address
First Line : 2122 MANCHESTER EXPY
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-6878
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2122 MANCHESTER EXPY
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-6878
Country : US
Telephone Number : 706-596-4014
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2026
Last Update Date : 04/02/2026

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Directions to “ ERIC TAEJIN PARK DO” Practice Location

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