Organization Active NPI

Mountain Top Primary Care Medical Associates

  • Primary Care Clinic/Center
  • Ellijay, GA
National Provider Identifier
1053638205
Registry record updated Apr 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
044665 Issued in GA
Legal business name
MOUNTAIN TOP PRIMARY CARE MEDICAL ASSOCIATES
Practice address
200 Industrial Blvd
Suite 114
Ellijay, GA 30540-3722
Phone
(706) 636-4364
Fax
(706) 636-5264
NPI assigned
Apr 28, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Muhammad Mateen Akmal, M.D.NPI 1932269818
Title
Physician
Phone
(706) 636-4364

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 044665 GA Primary

Addresses

Primary practice location

200 Industrial Blvd
Suite 114
Ellijay, GA 30540-3722

Mailing address

200 Industrial Blvd
Suite 114
Ellijay, GA 30540-3722
Phone (706) 636-4364

Other identifiers 1

IdentifierTypeStateIssuer
0083454545BMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100826000571 GA Part B Supplier - Clinic/Group Practice 8527085182 Receives reassigned benefits from 1 practitioner
Practice locations: Ellijay, GA

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

200 Industrial Blvd
Ste 114
Ellijay, GA 30540
Phone (706) 363-4364

200 Industrial Blvd
#B
Ellijay, GA 30540

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1272412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272412800000",
    "number": "1053638205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 INDUSTRIAL BLVD",
            "address_2": "SUITE 114",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305403722",
            "telephone_number": "706-636-4364",
            "fax_number": "706-636-5264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 INDUSTRIAL BLVD",
            "address_2": "SUITE 114",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305403722",
            "telephone_number": "706-636-4364",
            "fax_number": "706-636-5264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN TOP PRIMARY CARE MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-28",
        "last_updated": "2010-04-28",
        "status": "A",
        "authorized_official_last_name": "AKMAL",
        "authorized_official_first_name": "MUHAMMAD",
        "authorized_official_middle_name": "MATEEN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "706-636-4364",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "044665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0083454545B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellijay, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.