Provider Demographics
NPI:1346972163
Name:GROARK, PATRICK CORBY
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:CORBY
Last Name:GROARK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 NARROWS PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-8649
Mailing Address - Country:US
Mailing Address - Phone:205-362-7035
Mailing Address - Fax:
Practice Address - Street 1:203 NARROWS PKWY STE B
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-8649
Practice Address - Country:US
Practice Address - Phone:205-362-7035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician