Provider Demographics
NPI:1538281316
Name:PARK, CHRISTY C (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:C
Last Name:PARK
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 1:1932 ALCOA HWY
Mailing Address - Street 2:SUITE C-550
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1527
Mailing Address - Country:US
Mailing Address - Phone:865-546-6554
Mailing Address - Fax:865-522-4634
Practice Address - Street 1:1932 ALCOA HWY
Practice Address - Street 2:SUITE C-550
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1527
Practice Address - Country:US
Practice Address - Phone:865-546-6554
Practice Address - Fax:865-522-4634
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-097633207R00000X, 207RR0500X
TN42732207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL993310Medicaid
IL993310Medicaid