Ken Park (NPI# 1245214402, PAC ID# 1759366016) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is INTERNAL MEDICINE.
| Nation Provider ID (NPI) | 1245214402 |
| PAC ID by PECOS | 1759366016 |
| Professional Enrollment ID | I20040621001521 |
| Full Name | Ken Park |
| Organization Legal Name | OCONEE PRIMARY CARE, L.L.C. |
| Address |
1624 Mars Hill Rd B Watkinsville GA 30677-4813 |
| Phone Number | 7063101030 |
| Gender | M |
| Credential | MD |
| Medical School | MEDICAL COLLEGE OF GEORGIA |
| Graduation Year | 1998 |
| Primary Specialty | INTERNAL MEDICINE |
| Group Practice PAC ID | 4981749470 |
| Number of Group Practice Members | 2 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 110006 | ST MARY'S HOSPITAL |
| 110074 | PIEDMONT ATHENS REGIONAL MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 1624 Mars Hill Rd, B, Watkinsville, GA 30677-4813 | 7063101030 | OCONEE PRIMARY CARE, L.L.C. |
| Organization Legal Name | OCONEE PRIMARY CARE, L.L.C. |
| Physicians | 2 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Mary M Kim | Internal Medicine | Oconee Primary Care, L.L.C. | 1624 Mars Hill Rd, B, Watkinsville, GA 30677-4813 |
| Street Address |
1624 MARS HILL RD B |
| City | WATKINSVILLE |
| State | GA |
| Zip | 30677-4813 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Mary M Kim | Internal Medicine | Oconee Primary Care, L.L.C. | 1624 Mars Hill Rd, B, Watkinsville, GA 30677-4813 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| William E Rigsby | Internal Medicine | 1800 Hog Mountain Rd, Suite 103, Watkinsville, GA 30677-1935 | |
| Jeffrey A Davenport | Chiropractic | 1120 Mars Hill Rd, Suite 105, Watkinsville, GA 30677-4800 | |
| Linda M Hueseman | Family Practice | Greater Athens Physicians, Inc | 1550 Mars Hill Rd, Watkinsville, GA 30677-4836 |
| Robert A Baldwin | Optometry | Oconee Vision Group,llc | 2281 Hog Mountain Rd, Suite C, Watkinsville, GA 30677-4846 |
| Jeffrey S Hackleman | Optometry | Oconee Vision Group,llc | 2281 Hog Mountain Rd, Suite C, Watkinsville, GA 30677-4846 |
| Bruce Leonard Hammonds | Optometry | Oconee Vision Group,llc | 2281 Hog Mountain Rd, Suite C, Watkinsville, GA 30677-4846 |
| Robin Myers | Nurse Practitioner | St Mary's Medical Group, Inc | 2410 Hog Mountain Rd, Suite 201, Watkinsville, GA 30677-4850 |
| Suneetha Chekuri | Family Medicine | St Mary's Medical Group, Inc | 2410 Hog Mountain Rd, Suite 201, Watkinsville, GA 30677-4850 |
| Donovan A Gowdie | Podiatry | 2410 Hog Mountain Rd, Suite 107, Watkinsville, GA 30677-4850 | |
| Michelle H Woodard | Internal Medicine | 2410 Hog Mountain Rd, Suite 303, Watkinsville, GA 30677-4850 | |
| Find all physicians in zip 30677 | |||
| City | WATKINSVILLE |
| Zip Code | 30677 |
| Specialty | INTERNAL MEDICINE |
| City + Specialty | WATKINSVILLE + INTERNAL MEDICINE |
Please comment or provide details below to improve the information on Ken Park.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.