NPIMap

Organization Active NPI

Northlake Physician Practice Network, Inc.

Doing business as Women's Cancer Alliance

  • Gynecologic Oncology Physician
  • Tucker, GA
National Provider Identifier
1730110131
Registry record updated Aug 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecologic Oncology PhysicianTaxonomy code 207VX0201X
Legal business name
NORTHLAKE PHYSICIAN PRACTICE NETWORK, INC.
Doing business as
Women's Cancer Alliance
Practice address
1459 Montreal Rd
Suite 408
Tucker, GA 30084-6900
Phone
(770) 938-3440
NPI assigned
Jul 5, 2006
Last updated
Aug 29, 2007By the provider in NPPES
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
Mark Pickett
Title
VP
Phone
(770) 938-3440

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecologic Oncology Physician 207VX0201X NU Primary

Addresses

Primary practice location

1459 Montreal Rd
Suite 408
Tucker, GA 30084-6900

Mailing address

1459 Montreal Rd
Suite 408
Tucker, GA 30084-6900
Phone (770) 938-3440

Other names 1

  • Women's Cancer Alliance Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188345600000",
    "number": "1730110131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1459 MONTREAL RD",
            "address_2": "SUITE 408",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300846900",
            "telephone_number": "770-938-3440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1459 MONTREAL RD",
            "address_2": "SUITE 408",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300846900",
            "telephone_number": "770-938-3440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAKE PHYSICIAN PRACTICE NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2007-08-29",
        "status": "A",
        "authorized_official_last_name": "PICKETT",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "770-938-3440"
    },
    "taxonomies": [
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Women's Cancer Alliance",
            "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 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.