Northlake Medical & Wellness Center

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036281 Issued in GA

Legal business name

NORTHLAKE MEDICAL & WELLNESS CENTER

Practice address

2244 Henderson Mill Rd NE
Suite 108
Atlanta, GA 30345-2760

Phone

(678) 551-7810

Fax

(678) 551-7815

NPI assigned

Oct 31, 2011

Organization subpart

No

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

Authorized official

Name

Ms. Mary Cammack

Title

Practice Manager

Phone

(678) 551-7810

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1320019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320019200000",
    "number": "1235415696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2244 HENDERSON MILL RD NE",
            "address_2": "SUITE 108",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303452760",
            "telephone_number": "678-551-7810",
            "fax_number": "678-551-7815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2244 HENDERSON MILL RD NE",
            "address_2": "SUITE 108",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303452760",
            "telephone_number": "678-551-7810",
            "fax_number": "678-551-7815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAKE MEDICAL & WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-31",
        "last_updated": "2011-10-31",
        "status": "A",
        "authorized_official_last_name": "CAMMACK",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "678-551-7810",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "036281",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL INSURANCE",
            "identifier": "1649205642",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northern Georgia Anesthesia Associates, LLC
• Gina Michelle Northington, MD
• Northlake Anesthesia Professionals, LLC
• Northlake Dental Partners
• Northlake Eyecare Associates, LLC
• Northland Hearing Centers, Inc (NuEar Hearing Center)
• Northland Medical LLC (Atlanta Ketamine Center)
• Northside Acupuncture
• Northside Anesthesiology Consultants
• Northside Anesthesiology Consultants, LLC

• Internal Medicine Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2011; 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.