Provider Demographics
NPI:1215935606
Name:PARKS, HUGH KYLE (MD)
Entity type:Individual
Prefix:
First Name:HUGH
Middle Name:KYLE
Last Name:PARKS
Suffix:
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 1:200 N RIVER ST
Mailing Address - Street 2:
Mailing Address - City:CLAXTON
Mailing Address - State:GA
Mailing Address - Zip Code:30417-1659
Mailing Address - Country:US
Mailing Address - Phone:912-739-7710
Mailing Address - Fax:912-739-7343
Practice Address - Street 1:604B E LONG ST
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-5914
Practice Address - Country:US
Practice Address - Phone:912-739-7710
Practice Address - Fax:912-739-7343
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054328208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA694559760AMedicaid
E76002Medicare UPIN
GA02BDHWJMedicare PIN