# NORTHLAKE INTERNAL MEDICINE

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

## Provider details

- **NPI number:** 1710286414
- **Authorized official:** DR. JOHN WILLIAM BUDELL M.D, (OWNER)
- **Authorized official phone:** (770) 496-2929

## Contact information

- **Practice address:** 2175 NORTHLAKE PKWY, ST 142,BLDG 4, TUCKER, GA 30084-4163
- **Practice address phone:** (770) 496-2929
- **Practice address fax:** (770) 496-2930
- **Mailing address:** 2175 NORTHLAKE PKWY, ST 142,BLDG 4, TUCKER, GA 30084-4163
- **Mailing address phone:** (770) 496-2929
- **Mailing address fax:** (770) 496-2930

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 017369 | GA | Yes |

## Other

- **Enumeration date:** 03/21/2011
- **Last updated:** 03/21/2011