Provider Demographics
NPI:1003801432
Name:PRATT, PARKS WINFIELD III (MD)
Entity Type:Individual
Prefix:
First Name:PARKS
Middle Name:WINFIELD
Last Name:PRATT
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 1:4300 W MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1054
Mailing Address - Country:US
Mailing Address - Phone:334-793-9564
Mailing Address - Fax:334-671-8907
Practice Address - Street 1:4300 W MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1054
Practice Address - Country:US
Practice Address - Phone:334-793-9564
Practice Address - Fax:334-671-8907
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14110207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372146900Medicaid
GA00530967AMedicaid
AL000084921Medicaid
660000487Medicare PIN
AL000084921Medicare ID - Type Unspecified
FL372146900Medicaid
ALC73924Medicare UPIN