NPIMap

Organization Active NPI

Northlake Medical Center, LLC

  • General Acute Care Hospital
  • Tucker, GA
National Provider Identifier
1659458776
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
NORTHLAKE MEDICAL CENTER, LLC
Practice address
1455 Montreal Rd
Tucker, GA 30084-8100
Phone
(770) 270-3000
Fax
(770) 270-3199
NPI assigned
Nov 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Michael Gordian
Title
Cfo
Phone
(770) 270-3010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

1455 Montreal Rd
Tucker, GA 30084-8100

Mailing address

1455 Montreal Rd
Tucker, GA 30084-8100
Phone (770) 270-3000

Other identifiers 1

IdentifierTypeStateIssuer
11105BMedicaidSC

Other names 1

  • NORTHLAKE MEDICAL CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Northlake Medical Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1659458776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1455 MONTREAL RD",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300848100",
            "telephone_number": "770-270-3000",
            "fax_number": "770-270-3199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 MONTREAL RD",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300848100",
            "telephone_number": "770-270-3000",
            "fax_number": "770-270-3199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAKE MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GORDIAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "770-270-3010"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11105B",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHLAKE MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 22, 2020; 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.