NPIMap

Organization Active NPI

Northlake Internal Medicine

  • Medical Specialty Clinic/Center
  • Tucker, GA
National Provider Identifier
1710286414
Registry record updated Mar 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
017369 Issued in GA
Legal business name
NORTHLAKE INTERNAL MEDICINE
Practice address
2175 Northlake Pkwy
St 142,BLDG 4
Tucker, GA 30084-4163
Phone
(770) 496-2929
Fax
(770) 496-2930
NPI assigned
Mar 21, 2011
Last updated
Mar 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2011

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

Authorized official

Name
Dr. John William Budell, M.D,NPI 1972547198
Title
Owner
Phone
(770) 496-2929

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X 017369 GA Primary

Addresses

Primary practice location

2175 Northlake Pkwy
St 142,BLDG 4
Tucker, GA 30084-4163

Mailing address

2175 Northlake Pkwy
St 142,BLDG 4
Tucker, GA 30084-4163
Phone (770) 496-2929

National Provider Directory

National Provider Directory

Locations

2175 Northlake Pkwy
#4142
Tucker, GA 30084
Phone (770) 496-2929

2175 Northlake Pkwy
Ste 142
Tucker, GA 30084
Phone (770) 496-2929

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1300665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300665600000",
    "number": "1710286414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2175 NORTHLAKE PKWY",
            "address_2": "ST 142,BLDG 4",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844163",
            "telephone_number": "770-496-2929",
            "fax_number": "770-496-2930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2175 NORTHLAKE PKWY",
            "address_2": "ST 142,BLDG 4",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844163",
            "telephone_number": "770-496-2929",
            "fax_number": "770-496-2930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAKE INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-21",
        "last_updated": "2011-03-21",
        "status": "A",
        "authorized_official_last_name": "BUDELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-496-2929",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D,"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "GA",
            "license": "017369",
            "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 Mar 21, 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.