Provider Demographics
NPI:1922853514
Name:KOG INTEGRATED HEALTHCARE
Entity Type:Organization
Organization Name:KOG INTEGRATED HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-229-9005
Mailing Address - Street 1:1248 FORT BRAGG RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-4982
Mailing Address - Country:US
Mailing Address - Phone:984-229-9005
Mailing Address - Fax:919-362-0769
Practice Address - Street 1:1248 FORT BRAGG RD STE 200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-4982
Practice Address - Country:US
Practice Address - Phone:984-229-9005
Practice Address - Fax:919-362-0769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty