Individual
DR. KEN H. PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1624 MARS HILL RD STE B, WATKINSVILLE, GA 30677-4813
(706) 310-1030
Mailing address
1624 MARS HILL RD, SUITE B, WATKINSVILLE, GA 30677-4813
(706) 310-1030
(706) 705-1444
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
050049
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00904197A
—
GA
Enumeration date
12/01/2005
Last updated
07/19/2019
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