NPIMap

Organization Active NPI

Prime Doc of Haywood, PA

  • Internal Medicine Physician
  • Clyde, NC
National Provider Identifier
1992761886
Registry record updated Jul 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PRIME DOC OF HAYWOOD, PA
Practice address
262 Leroy George Drive
Clyde, NC 28721-7430
Phone
(828) 452-8862
Fax
(843) 237-5073
NPI assigned
Apr 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2015

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

Authorized official

Name
Dr. Talbot G. McCormick III, MD
Title
President
Phone
(678) 441-8500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

262 Leroy George Drive
Clyde, NC 28721-7430

Mailing address

5901-C Peachtree Dunwoody Road
Suite 350
Atlanta, GA 30328-7159
Phone (678) 441-8556

Other identifiers 3

IdentifierTypeStateIssuer
013PUOtherNCBLUE CROSS BLUE SHIELD
DC9720OtherNCRAILROAD MEDICARE
89013PUMedicaidNC

National Provider Directory

National Provider Directory

Locations

5901 Peachtree Dunwoody Rd
Ste 350
Sandy Springs, GA 30328
Phone (678) 441-8500

Practitioners & affiliated clinicians

Practitioners 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436486400000",
    "number": "1992761886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901-C PEACHTREE DUNWOODY ROAD",
            "address_2": "SUITE 350",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303287159",
            "telephone_number": "678-441-8556",
            "fax_number": "678-441-8656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "262 LEROY GEORGE DRIVE",
            "city": "CLYDE",
            "state": "NC",
            "postal_code": "287217430",
            "telephone_number": "828-452-8862",
            "fax_number": "843-237-5073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME DOC OF HAYWOOD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-21",
        "last_updated": "2015-07-10",
        "status": "A",
        "authorized_official_last_name": "MCCORMICK",
        "authorized_official_first_name": "TALBOT",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-441-8500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "013PU",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC9720",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89013PU",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clyde, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2015; 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.