SE J PARK (NPI# 1871031518) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871031518 |
| Entity Type | Individual |
| Full Name | SE J PARK |
| Credential | NP-C |
| Practice Address |
55 Whitcher St Ne Ste 250 Marietta GA 30060-1169 |
| Practice Telephone | 6787724055 |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2017-02-02 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | RN243386 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275178055 | Se Ryung Park | Acupuncturist | 15541 Williams St Apt D4, Tustin, CA 92780-4191 | 2019-11-15 |
| 1558761395 | Se Ra Park | Student in an Organized Health Care Education/Training Program | 456 Elm Ave, Long Beach, CA 90802-2426 | 2014-08-29 |
| Street Address |
55 WHITCHER ST NE STE 250 |
| City | MARIETTA |
| State | GA |
| Zip Code | 30060-1169 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346342128 | A Keith Levinson | Urology | 55 Whitcher St Ne Ste 250, Marietta, GA 30060-1169 | 2006-09-02 |
| 1336785732 | Faith Webster | Nurse Practitioner | 55 Whitcher St Ne Ste 250, Marietta, GA 30060-1169 | 2019-11-20 |
| 1184195653 | John Simuel Beasley IIi | Nurse Practitioner | 55 Whitcher St Ne Ste 250, Marietta, GA 30060-1169 | 2018-12-10 |
| 1679951180 | Anand Badri | Urology | 55 Whitcher St Ne Ste 250, Marietta, GA 30060-1169 | 2015-05-16 |
| 1841619152 | Daniel Mollengarden | Urology | 55 Whitcher St Ne Ste 250, Marietta, GA 30060 | 2014-04-15 |
| 1881012391 | Akash A. Kapadia | Urology | 55 Whitcher St Ne Ste 250, Marietta, GA 30060-1169 | 2014-04-01 |
| 1659711547 | Reena Kabaria | Urology | 55 Whitcher St Ne Ste 250, Marietta, GA 30060 | 2013-06-25 |
| 1437416054 | Samuel Adam David | Urology | 55 Whitcher St Ne Ste 250, Marietta, GA 30060-1169 | 2012-04-19 |
| 1043467038 | Gaspar Msangi | Urology | 55 Whitcher St Ne Ste 250, Marietta, GA 30060-1169 | 2008-08-21 |
| 1457490534 | Jermaine Frederick Taft | Physician Assistant | 55 Whitcher St Ne Ste 250, Marietta, GA 30060-1169 | 2007-02-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144845116 | Legacy Center for Spinal Surgery, LLC | Neurological Surgery | 1900 The Exchange, Ne, Suite 600, Marietta, GA 30060 | 2020-06-15 |
| 1407477193 | Michael Cynil Daniel | Counselor | 698 N Marietta, Pkwy, Marietta, GA 30060 | 2020-05-04 |
| 1285253401 | Cameron Thomas Kennelly | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne Attn:gme, Marietta, GA 30060 | 2020-04-09 |
| 1922640739 | Jeremiah George Blair | Physician Assistant | 61 Whitcher St Suite 2100, Marietta, GA 30060 | 2019-10-14 |
| 1164064945 | Denise Alicia Mick | Registered Nurse | 677 Church St Wellstar Kennestone Hospital, Marietta, GA 30060 | 2019-10-12 |
| 1184283772 | Iora Health Georgia, P.C. | Internal Medicine | 280 Cobb Pkwy Se, Suite 60, Marietta, GA 30060 | 2019-06-07 |
| 1346703212 | Caitlin Virginia Mueller | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne, Attn: Gme, Marietta, GA 30060 | 2019-04-08 |
| 1184187205 | Adero Francis | Student in an Organized Health Care Education/Training Program | Wellstar Kennestone Gme Internal Medicine Clinic, 833 Campbell Hill St Nw, Suite 250, Marietta, GA 30060 | 2019-04-08 |
| 1659832749 | Matthew Mozzo | Student in an Organized Health Care Education/Training Program | 677 Church Street / Lower Level, Gme Department / I.m., Marietta, GA 30060 | 2019-03-29 |
| 1245797430 | La'myia Spentz | Specialist | 109 Anderson St Ne, Suite 608, Marietta, GA 30060 | 2019-02-25 |
| Find all providers in zip 30060 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629677455 | Amy Lynn Patterson | Nurse Practitioner | 254 Senna St, Marietta, GA 30064-4417 | 2020-10-22 |
| 1356996748 | Katrina Nicole Likes | Nurse Practitioner | 2965 Johnson Ferry Rd Ste D, Marietta, GA 30062-8364 | 2019-08-02 |
| 1205488822 | Deborah Patterson Ott | Nurse Practitioner | 1165 Timberland Dr Se, Marietta, GA 30067-5120 | 2019-07-13 |
| 1922664754 | Amanda Lynn Mcelheney | Nurse Practitioner | 1997 Cheatham Woods Dr Sw, Marietta, GA 30008-4451 | 2019-05-16 |
| 1477020295 | Candi Holyfield | Nurse Practitioner | 1395 S Marietta Pkwy Se Ste 216, Marietta, GA 30067-7832 | 2018-10-30 |
| 1346755998 | Allen Surgical LLC | Nurse Practitioner | 3689 Mountain Rd Ne, Marietta, GA 30066-2411 | 2017-12-05 |
| 1437660305 | Tara Randall | Nurse Practitioner | 2810 Tanner Lake Trl Nw, Marietta, GA 30064-1200 | 2017-10-19 |
| 1487006912 | Tara B Pickens | Nurse Practitioner | 401 Matthew St Ste 200, Marietta, OH 45750-1635 | 2016-07-08 |
| 1528420452 | Shakia Frisby | Nurse Practitioner | 124 Powers Ferry Rd Se Ste E, Marietta, GA 30067-7579 | 2016-03-21 |
| 1912371782 | Renee Bateman Brown | Nurse Practitioner | 488 Kennesaw Ave Nw Ste 200, Marietta, GA 30060 | 2015-11-17 |
| Find all providers in MARIETTA | ||||
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| 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.