Northlake Obstetrics and Gynecology, PC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

NORTHLAKE OBSTETRICS AND GYNECOLOGY, PC

Practice address

3957 Holcomb Bridge Rd.
Suite 100
Norcross, GA 30092

Phone

(770) 939-5102

Fax

(770) 938-9323

NPI assigned

Jan 3, 2007

Organization subpart

No

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

Authorized official

Name

Gerardo L. Sotomayor, M.D.

Title

Owner

Phone

(770) 939-5102

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Interoperability endpoints

• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.729

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468195200000",
    "number": "1275690604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3957 HOLCOMB BRIDGE RD.",
            "address_2": "SUITE 100",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "30092",
            "telephone_number": "770-939-5102",
            "fax_number": "770-938-9323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3957 HOLCOMB BRIDGE RD.",
            "address_2": "SUITE 100",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "30092",
            "telephone_number": "770-939-5102",
            "fax_number": "770-938-9323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAKE OBSTETRICS AND GYNECOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2016-07-11",
        "status": "A",
        "authorized_official_last_name": "SOTOMAYOR",
        "authorized_official_first_name": "GERARDO",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-939-5102",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300026901A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA WAIVER",
            "identifier": "11D0255917",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Norcross, GA
• Obstetrics & Gynecology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2016; 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.