Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 2013-01396 | NC |
N | 207QS0010X | Family Doctor - Sports Medicine | MD37503 | SC |
NPI | 1285868117 |
---|---|
Provider Name | Augustus Garland Parker IV |
First Address | Charlotte, NC 28277-5731 |
Second Address | Charlotte, NC 28277-5731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2009 |
Last Update Date | 25/10/2020 |