Provider Demographics
NPI:1902572399
Name:PARKS, FABION ANDREW (P006465)
Entity type:Individual
Prefix:MR
First Name:FABION
Middle Name:ANDREW
Last Name:PARKS
Suffix:
Gender:M
Credentials:P006465
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 OLD ALABAMA RD SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-4111
Mailing Address - Country:US
Mailing Address - Phone:404-447-7296
Mailing Address - Fax:
Practice Address - Street 1:1069 OLD ALABAMA RD SW
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-4111
Practice Address - Country:US
Practice Address - Phone:404-447-7296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAP006465146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic