Provider Demographics
NPI:1558663658
Name:PARKS, GODFREY ANTHONY
Entity type:Individual
Prefix:MR
First Name:GODFREY
Middle Name:ANTHONY
Last Name:PARKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BANYAN PASS
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-8779
Mailing Address - Country:US
Mailing Address - Phone:352-361-0652
Mailing Address - Fax:
Practice Address - Street 1:24 BANYAN PASS
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-8779
Practice Address - Country:US
Practice Address - Phone:352-361-0652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)