# LAKESIDE CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477657823
- **Authorized official:** CAROLYN H MASON (ADMINISTRATOR)
- **Authorized official phone:** (256) 582-5131

## Contact information

- **Practice address:** 2337 HOMER CLAYTON DRIVE, GUNTERSVILLE, AL 35976
- **Practice address phone:** (256) 582-5131
- **Practice address fax:** (256) 582-1100
- **Mailing address:** 2337 HOMER CLAYTON DRIVE, GUNTERSVILLE, AL 35976
- **Mailing address phone:** (256) 582-5131
- **Mailing address fax:** (256) 582-1100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/07/2006
- **Last updated:** 04/24/2024