Provider Demographics
NPI:1013049881
Name:PARKS, FAYTH MARGARET (PHD)
Entity type:Individual
Prefix:DR
First Name:FAYTH
Middle Name:MARGARET
Last Name:PARKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 N KEVIN CT
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30461-2742
Mailing Address - Country:US
Mailing Address - Phone:803-397-7578
Mailing Address - Fax:
Practice Address - Street 1:609 N KEVIN CT
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30461-2742
Practice Address - Country:US
Practice Address - Phone:803-397-7578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC783103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPS0326Medicaid