Provider Demographics
NPI:1346335536
Name:GROW, PARKER CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:PARKER
Middle Name:CHARLES
Last Name:GROW
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1500 OGLETHORPE AVE
Mailing Address - Street 2:AUITE 600A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2179
Mailing Address - Country:US
Mailing Address - Phone:706-475-4933
Mailing Address - Fax:706-208-8259
Practice Address - Street 1:1199 PRINCE AVE
Practice Address - Street 2:MSB 2ND FLOOR
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2797
Practice Address - Country:US
Practice Address - Phone:706-475-1700
Practice Address - Fax:706-475-1790
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-01-05
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Provider Licenses
StateLicense IDTaxonomies
GA052943207RI0011X, 207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA681452771Medicaid
GA681452771Medicaid