Organization
PRIME DOC OF HAYWOOD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TALBOT G. MCCORMICK III MD (PRESIDENT)
(678) 441-8500
Entity
Organization
Contact information
Practice address
262 LEROY GEORGE DRIVE, CLYDE, NC 28721-7430
(828) 452-8862
(843) 237-5073
Mailing address
5901-C PEACHTREE DUNWOODY ROAD, SUITE 350, ATLANTA, GA 30328-7159
(678) 441-8556
(678) 441-8656
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
013PU
BLUE CROSS BLUE SHIELD
NC
05
—
89013PU
—
NC
01
—
DC9720
RAILROAD MEDICARE
NC
Enumeration date
04/21/2006
Last updated
07/10/2015
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