Provider Demographics
NPI:1255375424
Name:PARKER, AUGUSTUS G III (MD)
Entity type:Individual
Prefix:
First Name:AUGUSTUS
Middle Name:G
Last Name:PARKER
Suffix:III
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6331 CARMEL RD STE 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8286
Practice Address - Country:US
Practice Address - Phone:704-316-2557
Practice Address - Fax:704-316-2558
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046523207V00000X
NC2017-00484207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0549375Medicaid
OH0576572OtherMEDICARE PTAN
OHC03013Medicare UPIN