Provider Demographics
NPI:1194709352
Name:PARKS, JOSEPH W III (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:W
Last Name:PARKS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CAVENDER ST
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1931
Mailing Address - Country:US
Mailing Address - Phone:770-253-6616
Mailing Address - Fax:770-254-6185
Practice Address - Street 1:15 CAVENDER ST
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1931
Practice Address - Country:US
Practice Address - Phone:770-253-6616
Practice Address - Fax:770-254-6185
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020586208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00178417AMedicaid
GA00178417AMedicaid