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PROFESSIONAL PARK MEDICAL SERVICES, P.C.
NPI 1386662849
Family Medicine in Carrollton, GA

Active since July 17, 2006CLIA 11D0885496 · Waiver
SUITE 202, 100 PROFESSIONAL PARK, CARROLLTON, GA 30117(770) 832-6861(770) 832-9432 Get Directions Write a Review

NPPES record last updated: March 4, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Professional Park Medical Services, P.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROFESSIONAL PARK MEDICAL SERVICES, P.C. (NPI 1386662849) is a healthcare organization registered as a family medicine in Carrollton, Georgia and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through March 19, 2027 and lists Jefferson Taylor Gordon, Family Practice Md, as its authorized official.

NPPES Registry Identity

NPI1386662849
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NamePROFESSIONAL PARK MEDICAL SERVICES, P.C.
Location AddressSUITE 202, 100 PROFESSIONAL PARKCarrollton, GA 30117
Mailing AddressSuite 202, 100 Professional ParkCarrollton, GA 30117 · (770) 832-6861 · Fax (770) 832-9432
Phone(770) 832-6861
Fax(770) 832-9432
Organization SubpartNo
Authorized OfficialJefferson Taylor GordonFamily Practice Md · (770) 832-6861
Enumeration DateJuly 17, 2006
Last NPPES UpdateMarch 4, 2016
✔ NPI 1386662849 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
SUITE 202, Carrollton, GA 30117
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Other Identifiers 2

Medicare ID-Type UnspecifiedGRP1919
OtherCJ2154GA · Medicare Railroad

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D0885496

Professional Park Medical Services PC · Carrollton, GA
Active · expires Mar 19, 2027
CLIA Number11D0885496
Laboratory TypePhysician Office
Certificate Effective DateMarch 20, 2025
Certificate Expiration DateMarch 19, 2027
Laboratory DirectorJ Taylor Gordon
Laboratory Phone(770) 832-6861
Laboratory LocationProfessional Park Medical Services PC100 Professional Park Suite 202, Carrollton, GA 30117
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Professional Park Medical Services, P.C.'s NPI number?

The NPI number for Professional Park Medical Services, P.C. is 1386662849. It was assigned to this organization in the NPPES registry on July 17, 2006.

Where is Professional Park Medical Services, P.C. located?

Professional Park Medical Services, P.C. is located at Suite 202 100 Professional Park, Carrollton, GA 30117. The listed phone number is (770) 832-6861.

What is Professional Park Medical Services, P.C.'s specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Professional Park Medical Services, P.C. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D0885496) is associated with this NPI, valid through March 19, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Professional Park Medical Services, P.C. was last updated on March 4, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.