MOUNTAIN PARK PRIMARY CARE CENTER NPI 1497955678

NPI Information

  • NPI: 1497955678
  • Provider Name: MOUNTAIN PARK PRIMARY CARE CENTER
  • Classification: General Practice - 208D00000X
  • Entity Type: Organization
  • Address: 1755 E PARK PLACE BLVD
    STONE MOUNTAIN, GA
    ZIP 30087
  • Phone: (770) 469-2040

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NPI Details

MOUNTAIN PARK PRIMARY CARE CENTER is a general practice in Stone Mountain, GA. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee MOUNTAIN PARK PRIMARY CARE CENTER NPI is 1497955678. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1755 E PARK PLACE BLVD
STONE MOUNTAIN, GA
ZIP 30087-459
Phone: (770) 469-2040
Fax: (770) 469-7010

The provider's authorized official is William Walter Noyd .
The authorized official title is Owner/physician and has the following contact phone number (770) 469-2040.

The enumeration date for this NPI number is 7/24/2007 and was last updated on 7/24/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208D00000XGeneral Practice021187GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
101BDHPTMEDICARE OSCAR/CERTIFICATIONGEORGIA
2D30368MEDICARE UPINGEORGIA
310036820OTHERGEORGIAAMERIGROUP
400203761KMEDICAIDGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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