Provider Demographics
NPI:1942528518
Name:PARKS, JOHN TICE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TICE
Last Name:PARKS
Suffix:
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 1:3924 MINNESOTA AVE. NE
Mailing Address - Street 2:UNITY HEALTHCARE - MINNESOTA AVENUE CLINIC
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019
Mailing Address - Country:US
Mailing Address - Phone:202-398-8683
Mailing Address - Fax:202-627-7815
Practice Address - Street 1:3924 MINNESOTA AVE. NE
Practice Address - Street 2:UNITY HEALTHCARE - MINNESOTA AVENUE CLINIC
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019
Practice Address - Country:US
Practice Address - Phone:202-398-8683
Practice Address - Fax:202-627-7815
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD041594207Q00000X
NC164607390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program