Provider Demographics
NPI:1285068288
Name:PARKS, WILLIAM BRIAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRIAN
Last Name:PARKS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1886 CANOE RDG NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-6209
Mailing Address - Country:US
Mailing Address - Phone:770-324-5787
Mailing Address - Fax:
Practice Address - Street 1:1886 CANOE RDG NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-6209
Practice Address - Country:US
Practice Address - Phone:770-324-5787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002636103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical