Healthcare Provider Details

I. General information

NPI: 1023409653
Provider Name (Legal Business Name): PARKWAY MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 N POINT PKWY
ALPHARETTA GA
30022-2409
US

IV. Provider business mailing address

2328 10TH AVE N STE 302
LAKE WORTH FL
33461-6612
US

V. Phone/Fax

Practice location:
  • Phone: 678-762-0370
  • Fax:
Mailing address:
  • Phone: 561-318-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES STOKES
Title or Position: CEO
Credential:
Phone: 561-318-4455