Organization
NORTHLAKE MEDICAL CENTER, LLC
Active
Other names
NORTHLAKE MEDICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL GORDIAN (CFO)
(770) 270-3010
Entity
Organization
Contact information
Practice address
1455 MONTREAL RD, TUCKER, GA 30084-8100
(770) 270-3000
(770) 270-3199
Mailing address
1455 MONTREAL RD, TUCKER, GA 30084-8100
(770) 270-3000
(770) 270-3199
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110033
—
RI
Enumeration date
05/18/2006
Last updated
08/22/2020
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