Individual
RANDOLPH W PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD PSYD
Contact information
Practice address
1061 HARMON AVE, CLINICAL SUPPORT DIVISION ROOM 2J22, FORT STEWART, GA 31314-5641
(912) 435-6277
Mailing address
1061 HARMON AVENUE, ARMY CLINICAL SUPPORT DIVISION ROOM 2J22, FORT STEWART, GA 31314
(912) 435-6277
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PY6459
FL
Other
Enumeration date
01/22/2008
Last updated
05/19/2008
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