Provider Demographics
NPI:1356579627
Name:PARK, KEVIN U (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:U
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:900 CIRCLE 75 SEPKWY 1700
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3087
Mailing Address - Country:US
Mailing Address - Phone:770-953-6929
Mailing Address - Fax:770-953-6972
Practice Address - Street 1:1265 HIGHWAY 54 W
Practice Address - Street 2:SUITES 102 AND 308
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4548
Practice Address - Country:US
Practice Address - Phone:770-460-1900
Practice Address - Fax:770-719-1214
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA074050207XS0117X
GA74050207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine