Healthcare Provider Details

I. General information

NPI: 1124737408
Provider Name (Legal Business Name): PARK MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13851 HIGHWAY 28
WHITWELL TN
37397-5373
US

IV. Provider business mailing address

13851 HIGHWAY 28
WHITWELL TN
37397-5373
US

V. Phone/Fax

Practice location:
  • Phone: 423-658-9200
  • Fax: 423-658-2195
Mailing address:
  • Phone: 423-658-9200
  • Fax: 423-658-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES KENNEDY
Title or Position: OWNER
Credential:
Phone: 423-658-9200