Professional Park Medical Services, P.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PROFESSIONAL PARK MEDICAL SERVICES, P.C.

Practice address

Suite 202
100 Professional Park
Carrollton, GA 30117

Phone

(770) 832-6861

Fax

(770) 832-9432

NPI assigned

Jul 17, 2006

Organization subpart

No

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

Authorized official

Name

Jefferson Taylor Gordon, MD

Title

Family Practice MD

Phone

(770) 832-6861

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457049600000",
    "number": "1386662849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "SUITE 202",
            "address_2": "100 PROFESSIONAL PARK",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "30117",
            "telephone_number": "770-832-6861",
            "fax_number": "770-832-9432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SUITE 202",
            "address_2": "100 PROFESSIONAL PARK",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "30117",
            "telephone_number": "770-832-6861",
            "fax_number": "770-832-9432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL PARK MEDICAL SERVICES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2016-03-04",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "JEFFERSON",
        "authorized_official_middle_name": "TAYLOR",
        "authorized_official_title_or_position": "FAMILY PRACTICE MD",
        "authorized_official_telephone_number": "770-832-6861",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CJ2154",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Ashley Price, PA-C
• Primary Care Group of West Georgia
• Kimberly Ann Prince Korobov, MA, M.DIV, LPC, NCC
• Elizabeth Morris Prince, ED.S.
• Maxine Prince
• Publix Pharmacy
• Publix Super Markets Inc (Publix Pharmacy #0608)
• Yuesheng Qu, M.D.
• Loralye Queen, M.ED CF-SLP
• Bryan Quinn, MD

• Family Medicine Physician in Carrollton, GA
• Providers in Carrollton, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.