Individual
CECILIA PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3636 SATELLITE BLVD, #4A, DULUTH, GA 30096-4590
(470) 336-9635
Mailing address
2366 HARSHAW AVE, LAWRENCEVILLE, GA 30043-8209
(470) 336-9635
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
CHIR008961
GA
363LF0000X
Family Nurse Practitioner
Primary
RN240365
GA
Other
Enumeration date
12/21/2012
Last updated
02/13/2017
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