Organization
NORTHLAKE INTERNAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN WILLIAM BUDELL M.D, (OWNER)
(770) 496-2929
Entity
Organization
Contact information
Practice address
2175 NORTHLAKE PKWY, ST 142,BLDG 4, TUCKER, GA 30084-4163
(770) 496-2929
(770) 496-2930
Mailing address
2175 NORTHLAKE PKWY, ST 142,BLDG 4, TUCKER, GA 30084-4163
(770) 496-2929
(770) 496-2930
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
017369
GA
Other
Enumeration date
03/21/2011
Last updated
03/21/2011
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