National Provider Identifier Database

NORTHLAKE INTERNAL MEDICINE
Medical Specialty

An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).


Contact Information

NORTHLAKE INTERNAL MEDICINE
2175 NORTHLAKE PKWY
ST 142,BLDG 4
TUCKER, GA30084-4163
Phone: 770-496-2929
Fax: 770-496-2930
Website:
Specialty Taxonomy Code
* Medical Specialty 261QM2500X

* Indicates primary specialty

NPI Profile & details for NORTHLAKE INTERNAL MEDICINE

NPI Number 1710286414
Legal business name
LBN
NORTHLAKE INTERNAL MEDICINE
Authorized official JOHN BUDELL - (OWNER)
Entity Organization
Organization subpart No
Enumeration date 03/21/2011
Last updated 03/21/2011 - About 15 years ago
Sole proprietor1 Not specified
Identifiers
  • GA License #: 017369

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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