Provider Demographics
NPI:1538116132
Name:PARKS, CAROL R (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:R
Last Name:PARKS
Suffix:
Gender:F
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:PO BOX 5470
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37864-5470
Mailing Address - Country:US
Mailing Address - Phone:865-429-2331
Mailing Address - Fax:
Practice Address - Street 1:3158 SMOKIES EDGE ROAD
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862
Practice Address - Country:US
Practice Address - Phone:865-429-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD40622207P00000X
ALMD17573207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4131273OtherBCBS OF TENNESSEE
TNPENDINGMedicaid
TNF62814Medicare UPIN
TNPENDINGMedicaid