Organization
NORTHLAKE PHYSICIAN PRACTICE NETWORK INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK PICKETT (VP)
(678) 762-5037
Entity
Organization
Contact information
Practice address
1459 MONTREAL RD, 408, TUCKER, GA 30084-6900
(770) 938-3440
(770) 938-3443
Mailing address
1459 MONTREAL RD, 408, TUCKER, GA 30084-6900
(770) 938-3440
(770) 938-3443
Taxonomy
Speciality
Code
Description
License number
State
2086X0206X
Surgical Oncology Physician
Primary
—
—
Other
Enumeration date
06/03/2006
Last updated
08/22/2020
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