Provider Demographics
NPI:1881405728
Name:PARKMIUM LLC
Entity type:Organization
Organization Name:PARKMIUM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENNISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-257-2672
Mailing Address - Street 1:4315 MULBERRY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-1699
Mailing Address - Country:US
Mailing Address - Phone:470-257-2672
Mailing Address - Fax:
Practice Address - Street 1:4315 MULBERRY RIDGE LN
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-1699
Practice Address - Country:US
Practice Address - Phone:470-257-2672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty