| Organization Name: | MOUNTAIN PARK PRIMARY CARE CENTER |
| NPI Number: | 1497955678 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIAM WALTER NOYD (OWNER/PHYSICIAN) |
| Mailing Address: | 1755 E Park Place Blvd Stone Mountain |
| State: | GA US |
| Postal Code: | 300873459 |
| Phone Number: | 7704692040 |
| Fax Number: | 7704697010 |
| NPI Enumeration Date: | 07/24/2007 |
| NPI Last Update Date: | 07/24/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 021187 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |