Organization
NORTHLAKE OBSTETRICS AND GYNECOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERARDO L. SOTOMAYOR M.D. (OWNER)
(770) 939-5102
Entity
Organization
Contact information
Practice address
3957 HOLCOMB BRIDGE RD., SUITE 100, NORCROSS, GA 30092
(770) 939-5102
(770) 938-9323
Mailing address
3957 HOLCOMB BRIDGE RD., SUITE 100, NORCROSS, GA 30092
(770) 939-5102
(770) 938-9323
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11D0255917
CLIA WAIVER
GA
05
—
300026901A
—
GA
Enumeration date
01/03/2007
Last updated
07/11/2016
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