NPI age
20 years
Enumerated 2005-07-28
● Active
Type 1 · Individual
Ih Koo Park, MD
Park is 1 of 1 surgery providers in Ft Oglethorpe and 1 of 1389 in Georgia.
Primary specialty
Surgery
Plus 1 subspecialty
Licensed in
GA, TN
2 states
Status
Active
No deactivations on record
Last NPPES update
2012-09-28
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 1389 active surgery providers in Georgia.
NPI age
20 years
↑ 3 yr above median (17 yr)
State licenses
2 states
Top 85% — 14% of peers are multi-state
Subspecialties
0
28% of peers hold subspecialties
NPI lifetime · 2005 → 2026
2005-07Enumerated in NPPES
2005
2026
Where they practice
Practice location
100 Gross Crescent Cir
Ft Oglethorpe, GA 307423643
Mailing address
100 Gross Crescent Cir
Ft Oglethorpe, GA 307423643
Specialties
-
Surgery PrimaryA general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 00062059B |
Multi-state credentialing: Licensed in 2 states. Useful context for credentialers building cross-state provider networks.
Practice context
Part of a multi-provider practice. 7 other active providers share this practice address in NPPES.
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