Provider Demographics
NPI:1083107718
Name:PARK, PO EL (PA)
Entity Type:Individual
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First Name:PO EL
Middle Name:
Last Name:PARK
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Gender:F
Credentials:PA
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Mailing Address - Street 1:100 STONEFOREST DR STE 130
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-4881
Mailing Address - Country:US
Mailing Address - Phone:678-388-1621
Mailing Address - Fax:678-388-1627
Practice Address - Street 1:61 WHITCHER ST NE STE 2100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1179
Practice Address - Country:US
Practice Address - Phone:770-423-0595
Practice Address - Fax:678-391-5055
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2022-07-06
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical