NPIMap

Organization Active NPI

Northlake Multispecialty Associates LLC

  • Family Medicine Physician
  • Tucker, GA
National Provider Identifier
1124066261
Registry record updated Aug 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NORTHLAKE MULTISPECIALTY ASSOCIATES LLC
Practice address
1459 Montreal Rd
Suite 304
Tucker, GA 30084-6900
Phone
(770) 908-4444
Fax
(770) 908-4400
NPI assigned
Jun 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Chuck Locke
Title
VP
Phone
(615) 373-7604

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1459 Montreal Rd
Suite 304
Tucker, GA 30084-6900

Mailing address

1459 Montreal Rd
Suite 304
Tucker, GA 30084-6900
Phone (770) 908-4444

National Provider Directory

National Provider Directory

Locations

1459 Montreal Rd
Ste 304
Tucker, GA 30084
Phone (404) 251-3420

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188345600000",
    "number": "1124066261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1459 MONTREAL RD",
            "address_2": "SUITE 304",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300846900",
            "telephone_number": "770-908-4444",
            "fax_number": "770-908-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1459 MONTREAL RD",
            "address_2": "SUITE 304",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300846900",
            "telephone_number": "770-908-4444",
            "fax_number": "770-908-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAKE MULTISPECIALTY ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2007-08-29",
        "status": "A",
        "authorized_official_last_name": "LOCKE",
        "authorized_official_first_name": "CHUCK",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "615-373-7604"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucker, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.