Eric Park, D.M.D

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

012946 Issued in GA

Practice address

4935 Stewart Mill Rd
Suite 200
Douglasville, GA 30135-6733

Phone

(770) 627-3042

Fax

(770) 627-3243

NPI assigned

Aug 14, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 28, 2016 through Jun 28, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dental Town, LLC

  • Dentist
  • Cumming, GA
  • NPI 1457657439
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1250208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288915200000",
    "number": "1144452830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97 EAGLE ROCK DR",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301011916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4935 STEWART MILL RD",
            "address_2": "SUITE 200",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301356733",
            "telephone_number": "770-627-3042",
            "fax_number": "770-627-3243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "ERIC",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-14",
        "last_updated": "2010-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "GA",
            "license": "012946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Josephine Paccione, M.D
• Ilka Palmer, RBT
• Kim Palombo
• Ganesh Pranshankar Pandya, MD
• Dulari K. Parikh, R.PH
• Christopher Austin Parker, PHARM.D., BCPS
• Christy Amos Parker, PHARMD
• Derkeriyah Parker, RBT
• Marjorie Parker, NP
• Parkway Physicians Practice Company

• Orthodontics and Dentofacial Orthopedics Dentistry in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.