Provider Demographics
NPI:1285868117
Name:PARKER, AUGUSTUS GARLAND IV (MD)
Entity Type:Individual
Prefix:
First Name:AUGUSTUS
Middle Name:GARLAND
Last Name:PARKER
Suffix:IV
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5815 BLAKENEY PARK DR
Mailing Address - Street 2:SUITE 200 B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-5731
Mailing Address - Country:US
Mailing Address - Phone:919-259-5897
Mailing Address - Fax:704-316-5085
Practice Address - Street 1:5815 BLAKENEY PARK DR
Practice Address - Street 2:SUITE 200 B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-5731
Practice Address - Country:US
Practice Address - Phone:919-259-5897
Practice Address - Fax:704-316-5085
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2020-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SCMD37503207QS0010X
NC2013-01396207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine