Provider Demographics
NPI:1063553733
Name:MOUNTAIN VIEW PRIMARY CARE, INC
Entity type:Organization
Organization Name:MOUNTAIN VIEW PRIMARY CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-695-0466
Mailing Address - Street 1:320 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-2843
Mailing Address - Country:US
Mailing Address - Phone:706-695-0466
Mailing Address - Fax:706-695-0741
Practice Address - Street 1:320 W MARKET ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-2843
Practice Address - Country:US
Practice Address - Phone:706-695-0466
Practice Address - Fax:706-695-0741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4470Medicare UPIN