Individual
MICHELLE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
310 KENNESTONE HOSPITAL BLVD, MARIETTA, GA 30060-1120
(770) 793-7899
(770) 793-7856
Mailing address
310 KENNESTONE HOSPITAL BLVD, MARIETTA, GA 30060-1120
(770) 793-7899
(770) 793-7856
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
88910
GA
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
88910
GA
Other
Enumeration date
03/23/2017
Last updated
09/06/2023
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