Provider Demographics
NPI:1821005554
Name:PARKS, ROSEMARIE D (MD)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:D
Last Name:PARKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-3525
Mailing Address - Country:US
Mailing Address - Phone:912-285-6010
Mailing Address - Fax:912-284-2980
Practice Address - Street 1:604 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5323
Practice Address - Country:US
Practice Address - Phone:912-285-6010
Practice Address - Fax:912-284-2980
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA057142207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine