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General NPI Number Information
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NPI Number | 1821005554
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Entity Type | Individual
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Provider Name | ROSEMARIE D PARKS MD
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Gender | Female
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 604 RIVERSIDE AVE
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City | WAYCROSS
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State | GA
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Zip | 31501-5323
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Country | US
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Telephone | 912-285-6010
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Fax | 912-284-2980
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Provider Business Mailing Address
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Address Line | 1101 CHURCH ST
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City | WAYCROSS
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State | GA
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Zip | 31501-3525
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Country | US
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Telephone | 912-285-6010
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Fax | 912-284-2980
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 057142
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License Number State | GA
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