Organization
MOUNTAIN PARK PRIMARY CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM WALTER NOYD M.D. (OWNER/PHYSICIAN)
(770) 469-2040
Entity
Organization
Contact information
Practice address
1755 E PARK PLACE BLVD, STONE MOUNTAIN, GA 30087-3459
(770) 469-2040
(770) 469-7010
Mailing address
1755 E PARK PLACE BLVD, STONE MOUNTAIN, GA 30087-3459
(770) 469-2040
(770) 469-7010
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
021187
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00203761K
—
GA
01
—
10036820
AMERIGROUP
GA
Enumeration date
07/24/2007
Last updated
07/24/2007
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