| Mountain Park Primary Care Center | |
|
1755 E Park Place Blvd Stone Mountain GA 30087-3459 | |
| (770) 469-2040 | |
| (770) 469-7010 |
| Full Name | Mountain Park Primary Care Center |
|---|---|
| Speciality | General Practice |
| Location | 1755 E Park Place Blvd, Stone Mountain, Georgia |
| Authorized Official Name and Position | William Walter Noyd (OWNER/PHYSICIAN) |
| Authorized Official Contact | 7704692040 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain Park Primary Care Center 1755 E Park Place Blvd Stone Mountain GA 30087-3459 Ph: (770) 469-2040 | Mountain Park Primary Care Center 1755 E Park Place Blvd Stone Mountain GA 30087-3459 Ph: (770) 469-2040 |
| NPI Number | 1497955678 |
|---|---|
| Provider Enumeration Date | 07/24/2007 |
| Last Update Date | 07/24/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497955678 | NPI | - | NPPES |
| 10036820 | Other | GA | AMERIGROUP |
| 00203761K | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 021187 (Georgia) | Primary |
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