# MOUNTAIN PARK PRIMARY CARE CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497955678
- **Authorized official:** DR. WILLIAM WALTER NOYD M.D. (OWNER/PHYSICIAN)
- **Authorized official phone:** (770) 469-2040

## Contact information

- **Practice address:** 1755 E PARK PLACE BLVD, STONE MOUNTAIN, GA 30087-3459
- **Practice address phone:** (770) 469-2040
- **Practice address fax:** (770) 469-7010
- **Mailing address:** 1755 E PARK PLACE BLVD, STONE MOUNTAIN, GA 30087-3459
- **Mailing address phone:** (770) 469-2040
- **Mailing address fax:** (770) 469-7010

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 021187 | GA | Yes |

## Other

- **Enumeration date:** 07/24/2007
- **Last updated:** 07/24/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00203761K | — | GA |
| 01 | — | 10036820 | AMERIGROUP | GA |