Provider Demographics
NPI:1043335151
Name:MCKINLEY, DAVID PARKS SR (MD,)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PARKS
Last Name:MCKINLEY
Suffix:SR
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:PO BOX 11407
Mailing Address - Street 2:DEPT#5839
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246
Mailing Address - Country:US
Mailing Address - Phone:256-386-4066
Mailing Address - Fax:256-386-4067
Practice Address - Street 1:1300 S MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-6334
Practice Address - Country:US
Practice Address - Phone:256-386-4433
Practice Address - Fax:256-386-4699
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5762208600000X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529926920Medicaid
ALC70866Medicare UPIN
AL529926920Medicaid