Organization
TROOP MEDICAL CLINIC #4
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PATRICK MICHAEL PARKS PHYSICIAN ASSISTANT (PHYSICIAN ASSISTANT)
(912) 435-5179
Entity
Organization
Contact information
Practice address
1061 HARMON AVE, STE 1D03, WINN ARMY COMMUNITY HOSPITAL, FT. STEWART, GA 31314-5611
(912) 435-6933
Mailing address
92 BRITTANY CT, RICHMOND HILL, GA 31324-5184
(912) 727-3073
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
004529
GA
Other
Enumeration date
10/17/2005
Last updated
08/22/2020
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