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General NPI Number Information
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NPI Number | 1245314780
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Entity Type | Organization
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Legal Business Name | J PARKS MEDICAL LLC
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 1010 DAWSONVILLE HWY
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City | GAINESVILLE
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State | GA
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Zip | 30501-2621
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Country | US
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Telephone | 770-533-8329
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Fax |
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Provider Business Mailing Address
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Address Line | 320 BROWN DR
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City | CLERMONT
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State | GA
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Zip | 30527-1753
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Country | US
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Telephone | 770-538-5734
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. JAMES FREDERICK PARKS
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Credential | MD
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Telephone | 770-538-5734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 018176
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License Number State | GA
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