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General NPI Number Information
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NPI Number | 1992761886
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Entity Type | Organization
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Legal Business Name | PRIME DOC OF HAYWOOD, PA
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 07/10/2015
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Provider Practice Location Address
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Address Line | 262 LEROY GEORGE DRIVE
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City | CLYDE
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State | NC
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Zip | 28721-7430
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Country | US
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Telephone | 828-452-8862
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Fax | 843-237-5073
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Provider Business Mailing Address
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Address Line | 5901-C PEACHTREE DUNWOODY ROAD SUITE 350
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City | ATLANTA
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State | GA
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Zip | 30328-7159
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Country | US
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Telephone | 678-441-8556
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Fax | 678-441-8656
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TALBOT G. MCCORMICK III
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Credential | MD
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Telephone | 678-441-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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