DR. KEVIN U PARK (NPI# 1356579627) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356579627 |
| Entity Type | Individual |
| Full Name | DR. KEVIN U PARK |
| Credential | MD |
| Practice Address |
1265 Highway 54 W Suites 102 and 308 Fayetteville GA 30214-4548 |
| Mailing Address |
900 Circle 75 Sepkwy 1700 Atlanta GA 30339-3087 |
| Practice Telephone | 7704601900 |
| Practice Fax Number | 7707191214 |
| Mailing Telephone | 7709536929 |
| Mailing Fax Number | 7709536972 |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2015-08-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XS0117X |
Orthopaedic Surgery Specialization: Orthopaedic Surgery of the Spine |
074050 | GA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013045343 | Kevin Warren Park | Psychiatry & Neurology | 124 River Rd, Kinship Center, Salinas, CA 93908-9601 | 2007-02-28 |
| 1952372914 | Kevin N Park | Psychologist | 5860 S Curtice St, Littleton, CO 80120-1909 | 2006-01-30 |
| 1891308417 | Kevin Park | Pharmacist | 7789 Foothill Blvd, Tujunga, CA 91042-2137 | 2020-08-24 |
| 1619462314 | Kevin Park | Student in an Organized Health Care Education/Training Program | 333 City Blvd W Ste 2150, Orange, CA 92868-5920 | 2018-06-25 |
| 1295102317 | Kevin Park | Dentist | 1365 Barrow St, Abilene, TX 79605-5171 | 2015-08-24 |
| 1649653106 | Kevin Woo Park | Orthopaedic Surgery | 9500 Euclid Ave # A41, Cleveland, OH 44195-0001 | 2015-07-02 |
| 1093103004 | Kevin Park | Pharmacist | 1496 Market St, San Francisco, CA 94102-6004 | 2014-12-26 |
| 1538456710 | Kevin Park | Pharmacist | 12051 Imperial Hwy, Norwalk, CA 90650-3084 | 2011-07-07 |
| 1215004965 | Kevin Alan Park | Occupational Therapist | 206b Oxford Rd, New Albany, MS 38652-3115 | 2006-11-29 |
| 1093823494 | Kevin S. Park | Orthopaedic Surgery | 11525 Brookshire Ave, Suite #201, Downey, CA 90241-4985 | 2006-08-26 |
| Street Address |
1265 HIGHWAY 54 W SUITES 102 AND 308 |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214-4548 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053315820 | John E Burney | Internal Medicine | 1265 Highway 54 W, Ste 402, Fayetteville, GA 30214-4537 | 2005-06-09 |
| 1417314527 | Amanda Murphy | Specialist/Technologist | 1265 Highway 54 W, Suite 102, Fayetteville, GA 30214-4548 | 2016-01-20 |
| 1366854077 | Kimberly Michelle Diprima | Physician Assistant | 1265 Highway 54 W, Suite 102, Fayetteville, GA 30214-4548 | 2014-05-29 |
| 1710248901 | Mandy G Osburn | Physical Therapist | 1265 Highway 54 W, Suite 102 & 308, Fayetteville, GA 30214-4548 | 2012-06-04 |
| 1104190990 | Jarryd A Jackson | Pharmacist | 1265 Highway 54 W, Suite #201, Fayetteville, GA 30214-4548 | 2012-02-27 |
| 1265704860 | Veketa Harris Smith | Physician Assistant | 1265 Highway 54 W, Suite 201, Fayetteville, GA 30214-4548 | 2012-01-30 |
| 1215225560 | Progressive Anesthesia LLC | Nurse Anesthetist, Certified Registered | 1265 Highway 54 W, Fayetteville, GA 30214-4548 | 2011-07-20 |
| 1881982817 | Ford H Cooper | Physical Therapist | 1265 Highway 54 W, Suite 308, Fayetteville, GA 30214-4548 | 2011-07-12 |
| 1518283308 | Ameera Waseem Siddiqi | Internal Medicine | 1265 Highway 54 W, Suite 201, Fayetteville, GA 30214-4548 | 2010-04-19 |
| 1316263494 | Ashlea Lakesha Cannon | Physician Assistant | 1265 Highway 54 W, Suite 102, Fayetteville, GA 30214-4548 | 2010-04-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
| 1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
| 1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
| 1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
| Find all providers in zip 30214 | ||||
| Taxonomy Code | 207XS0117X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Orthopaedic Surgery of the Spine |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with the evaluation and nonoperative and operative treatment of the full spectrum of primary spinal disorders including trauma, degenerative, deformity, tumor, and reconstructive. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184122962 | Spine Cin of Atlanta LLC | Orthopaedic Surgery | 10 Glenlake Pkwy Ste 130a, Atlanta, GA 30328-3495 | 2018-01-26 |
| 1295243061 | Joint Replacement Cin of Atlanta LLC | Orthopaedic Surgery | 10 Glenlake Pkwy # 130b, Atlanta, GA 30328-3495 | 2018-01-16 |
| 1124568480 | Macon Orthopaedic & Hand Center, Pa | Orthopaedic Surgery | 109 Fairview Park Dr, Dublin, GA 31021-2562 | 2017-03-06 |
| 1588056873 | Spinecentersavannah, LLC | Orthopaedic Surgery | 1266 W Paces Ferry Rd Nw, Box 437, Atlanta, GA 30327-2306 | 2015-02-24 |
| 1811134133 | Sharonda Renee Forte | Orthopaedic Surgery | 4940 Governors Park Drive, Forest Park, GA 30297 | 2009-01-08 |
| 1851455877 | Plas T James | Orthopaedic Surgery | 3200 Downwood Cir Nw Ste 500, Atlanta, GA 30327-1659 | 2006-12-21 |
| 1376602565 | Premier Orthopaedic Surgery, LLC | Orthopaedic Surgery | 7360 Mcginnis Ferry Rd, Suite E, Suwanee, GA 30024-6603 | 2006-12-06 |
| 1992810105 | Sangwook Tim Yoon | Orthopaedic Surgery | 59 Executive Park South Ne Ste 3000, Atlanta, GA 30329-2208 | 2006-08-20 |
| 1295745081 | Andrew G Cordista | Orthopaedic Surgery | 8 Live Oak Ct, Moultrie, GA 31768-6783 | 2006-08-08 |
| 1952376337 | Todd C Bonvallet | Orthopaedic Surgery | 6262 Veterans Pkwy, Columbus, GA 31909-3540 | 2006-02-21 |
| Find all providers with the same taxonomy | ||||
| City | FAYETTEVILLE |
| Zip Code | 30214 |
Please comment or provide details below to improve the information on DR. KEVIN U PARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.