Organization
NORTHLAKE PEDIATRIC ASSOCIATES,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DELORES TALIAFERRO (OFFICE MANAGER)
(770) 498-9355
Entity
Organization
Contact information
Practice address
1805 PARKE PLAZA CIR, SUITE 103, STONE MOUNTAIN, GA 30087-3498
(770) 498-9355
(770) 498-6294
Mailing address
1805 PARKE PLAZA CIR, SUITE 103, STONE MOUNTAIN, GA 30087-3498
(770) 498-9355
(770) 498-6294
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
85000926G
—
GA
Enumeration date
05/16/2007
Last updated
01/08/2014
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