Provider Demographics
NPI:1124011754
Name:PARKS, RHONDA KAY (MD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:KAY
Last Name:PARKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8095 CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-5976
Mailing Address - Country:US
Mailing Address - Phone:901-758-6035
Mailing Address - Fax:901-758-6029
Practice Address - Street 1:8095 CLUB PKWY
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5976
Practice Address - Country:US
Practice Address - Phone:901-758-6035
Practice Address - Fax:901-758-6029
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30580207Q00000X
MS19167207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02557301Medicaid
MS5420022OtherCIGNA
MS080004220Medicare ID - Type UnspecifiedMS MEDICARE
MS5420022OtherCIGNA
TN3828405Medicare ID - Type Unspecified