Organization
NORTHLAKE MEDICAL & WELLNESS CENTER
Active
Organization
NORTHLAKE MEDICAL & WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY CAMMACK (PRACTICE MANAGER)
(678) 551-7810
Entity
Organization
Contact information
Practice address
2244 HENDERSON MILL RD NE, SUITE 108, ATLANTA, GA 30345-2760
(678) 551-7810
(678) 551-7815
Mailing address
2244 HENDERSON MILL RD NE, SUITE 108, ATLANTA, GA 30345-2760
(678) 551-7810
(678) 551-7815
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036281
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1649205642
COMMERCIAL INSURANCE
GA
Enumeration date
10/31/2011
Last updated
10/31/2011
Update your record
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