Mountain Park Primary Care Center

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

021187 Issued in GA

Legal business name

MOUNTAIN PARK PRIMARY CARE CENTER

Practice address

1755 E Park Place Blvd
Stone Mountain, GA 30087-3459

Phone

(770) 469-2040

Fax

(770) 469-7010

NPI assigned

Jul 24, 2007

Organization subpart

No

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

Authorized official

Name

Dr. William Walter Noyd, M.D.

Title

Owner/Physician

Phone

(770) 469-2040

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185235200000",
    "number": "1497955678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1755 E PARK PLACE BLVD",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873459",
            "telephone_number": "770-469-2040",
            "fax_number": "770-469-7010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1755 E PARK PLACE BLVD",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873459",
            "telephone_number": "770-469-2040",
            "fax_number": "770-469-7010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN PARK PRIMARY CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-24",
        "last_updated": "2007-07-24",
        "status": "A",
        "authorized_official_last_name": "NOYD",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "WALTER",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "770-469-2040",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "GA",
            "license": "021187",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10036820",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00203761K",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• General Practice Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.