institution
Mountain Park Primary Care Center
General Practice Physician in Stone Mountain, Georgia
NPI 1497955678

Mountain Park Primary Care Center is a General Practice Physician based in Stone Mountain, GA. Mountain Park Primary Care Center practices in Stone Mountain, GA. The NPI Number for Mountain Park Primary Care Center is 1497955678 and holds a License No. 021187 (Georgia).

The current practice location address for Mountain Park Primary Care Center is 1755 E Park Place Blvd, Stone Mountain, GA and can be reached out via phone at 770-469-2040 and via fax at 770-469-7010.

Location: 1755 E Park Place Blvd, Stone Mountain, GA, 30087-3459
institution
Provider Profile Details
NPI Number
1497955678
Provider Name
Mountain Park Primary Care Center
Credential
Provider Entity Type
Organization
Address
1755 E Park Place Blvd, Stone Mountain, GA, 30087-3459
Phone Number
770-469-2040
Fax Number
770-469-7010
Provider Enumeration Date
07/24/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
10036820 01 GA AMERIGROUP
00203761K 05 GA
institution
Provider Business Practice Location Address Details
Address
1755 E Park Place Blvd
City
State
Zip
30087-3459
Phone Number
770-469-2040
Fax Number
770-469-7010
person
Provider Business Mailing Address Details
Address
1755 E Park Place Blvd
City
State
Zip
30087-3459
Phone Number
770-469-2040
Fax Number
770-469-7010
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
General Practice
Speciality
-
Taxonomy
License No.
021187 (Georgia)
Definition
Definition to come...
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