Provider Demographics
NPI:1164418661
Name:PARKS, JANE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:M
Last Name:PARKS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3320 OLD JEFFERSON RD
Mailing Address - Street 2:STE 200A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1400
Mailing Address - Country:US
Mailing Address - Phone:706-549-5560
Mailing Address - Fax:706-543-2593
Practice Address - Street 1:3320 OLD JEFFERSON RD
Practice Address - Street 2:STE 200A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1400
Practice Address - Country:US
Practice Address - Phone:706-549-5560
Practice Address - Fax:706-543-2593
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2009-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA46556207RP1001X, 207RC0200X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00808266AMedicaid
F58138Medicare UPIN
GA00808266AMedicaid