Provider Demographics
NPI:1053638205
Name:MOUNTAIN TOP PRIMARY CARE MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:MOUNTAIN TOP PRIMARY CARE MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:MATEEN
Authorized Official - Last Name:AKMAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-636-4364
Mailing Address - Street 1:200 INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-3722
Mailing Address - Country:US
Mailing Address - Phone:706-636-4364
Mailing Address - Fax:706-636-5264
Practice Address - Street 1:200 INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 114
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-3722
Practice Address - Country:US
Practice Address - Phone:706-636-4364
Practice Address - Fax:706-636-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044665261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0083454545BMedicaid
GA0083454545BMedicaid