Individual ProviderAnnie ParkHospitalistAllopathic & Osteopathic PhysiciansPractice Address450 Northside Cherokee Blvd, Canton, GA 30115-8015(770) 224-1000(256) 265-3880PECOS EnrollmentBased on the most recent information from CMS, provider Annie Park is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1194165944Provider TypeIndividualFull NamePark, AnnieTitleDr.CredentialD.O.GenderFemaleSole ProprietorNoEnumeration Date6/26/2013Last Updated1/10/2020Contact InformationPractice LocationPractice Address450 Northside Cherokee Blvd, Canton, GA 30115-8015Phone(770) 224-1000Fax(770) 224-2451Mailing LocationMailing AddressPO Box 2705, Huntsville, AL 35804-2705Phone(256) 265-3880Fax(256) 265-3886Provider TaxonomiesCodeDescriptionLicenseCode208M00000XPrimaryDescriptionHospitalistAllopathic & Osteopathic PhysiciansLicense79236GeorgiaCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense079236GeorgiaCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense1688Alabama