Ih Koo Park, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

15885 Issued in GA

Practice address

100 Gross Crescent Cir
Ft Oglethorpe, GA 30742-3643

Phone

(706) 861-7275

NPI assigned

Jul 28, 2005

Last updated

Sep 28, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Surgical Specialists, P.C.

  • Surgery Physician
  • Ringgold, GA
  • NPI 1053368696
  NPD (past)

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348790400000",
    "number": "1902806227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 GROSS CRESCENT CIR",
            "city": "FT OGLETHORPE",
            "state": "GA",
            "postal_code": "307423643",
            "telephone_number": "706-861-7275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 GROSS CRESCENT CIR",
            "city": "FT OGLETHORPE",
            "state": "GA",
            "postal_code": "307423643",
            "telephone_number": "706-861-7275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "IH",
        "middle_name": "KOO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2012-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "15885",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TN",
            "license": "8922",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00062059B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Randall K Overton, RPH
• Charles Eugene Owens Jr., DDS
• Marilyn R Owens, PTA
• Katherine Suzanne Palmer, MS, CCC-SLP
• Trinity Grace Parham, CCC-SLP
• David F Parker, RPH
• Andrew Christopher Parsons, DPT
• Jay Patel, PA-C
• Jignaben Patel, PHARMACIST
• Mitansu A Patel, PHARMD.

• Surgery Physician in Fort Oglethorpe, GA
• Providers in Fort Oglethorpe, GA by specialty
• Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2012; 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.