Healthcare Provider Details

I. General information

NPI: 1154387140
Provider Name (Legal Business Name): STEPHEN E PARKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 RAY E TALLEY CT
SIMPSONVILLE SC
29680-6772
US

IV. Provider business mailing address

1818 HENDERSON ST
COLUMBIA SC
29201-2647
US

V. Phone/Fax

Practice location:
  • Phone: 864-967-7028
  • Fax: 864-228-0915
Mailing address:
  • Phone: 803-782-4278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number10976
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10976
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: