Teklewold H Lake, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

005767 Issued in GA

Practice address

2830 Clearview PL
Suite 500
Doraville, GA 30340-2134

Phone

(678) 638-0888

Fax

(678) 507-2360

NPI assigned

Apr 27, 2010

Last updated

Apr 27, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Georgia Emergency Department Services, P.C.

  • Emergency Medicine Physician
  • Gainesville, GA
  • NPI 1508886912
  Medicare reassignment
• Northside Emergency Associates, LLC

  • Emergency Medicine Physician
  • Sandy Springs, GA
  • NPI 1285686303
  Medicare reassignment
• Acs Primary Care Physicians - Southeast PC

  • Emergency Medicine Physician
  • Myrtle Beach, SC
  • NPI 1861430555

  GA

  Medicare reassignment
• Atlanta Hope Medical Group Inc

  • Family Medicine Physician
  • Doraville, GA
  • NPI 1447404835
  NPD (past)
• Lavender Inpatient Services LLC

  • Internal Medicine Physician
  • Cartersville, GA
  • NPI 1902215767
  NPD (past)
• Mount Lassen Emergency Physicians LLC

  • Emergency Medicine Physician
  • Cartersville, GA
  • NPI 1730598590
  NPD (past)

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

{
    "created_epoch": "1272326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272326400000",
    "number": "1932426210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2830 CLEARVIEW PL",
            "address_2": "SUITE 500",
            "city": "DORAVILLE",
            "state": "GA",
            "postal_code": "303402134",
            "telephone_number": "678-638-0888",
            "fax_number": "678-507-2360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2830 CLEARVIEW PL",
            "address_2": "SUITE 500",
            "city": "DORAVILLE",
            "state": "GA",
            "postal_code": "303402134",
            "telephone_number": "678-638-0888",
            "fax_number": "678-507-2360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "TEKLEWOLD",
        "middle_name": "H",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-27",
        "last_updated": "2010-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "005767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA LICENSE",
            "identifier": "005767",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kun Zoo Kim, M.D.
• Lia Kim
• Meu Keon Kim, LAC
• Krasna Seng Kuoch, D.N., P.M.D (IP) DEM
• Yong Ku Kwon, PA
• Elizabeth Kim Le, RDMS
• Dong Ha Lee, DDS
• Thalandus Lee
• Yong Li, LIC, A
• Lifeguard Ambulance Service of Georgia, LLC

• Physician Assistant in Doraville, GA
• Providers in Doraville, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.