Individual
YONG D. PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 15TH STREET, AUGUSTA, GA 30912
(706) 721-3371
(706) 721-3377
Mailing address
1499 WALTON WAY, STE 1400, AUGUSTA, GA 30901-2650
(706) 828-6410
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
035114
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000473459A
—
GA
05
—
G07909
—
SC
Enumeration date
09/22/2006
Last updated
03/31/2011
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