Provider Demographics
NPI:1487821369
Name:PARK, ERNEST LITTLETON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:LITTLETON
Last Name:PARK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 ANNANDALE CRES
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2901
Mailing Address - Country:US
Mailing Address - Phone:205-967-6396
Mailing Address - Fax:
Practice Address - Street 1:207 ANNANDALE CRES
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35223-2901
Practice Address - Country:US
Practice Address - Phone:205-967-6396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-10
Last Update Date:2008-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry