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Organization

NORTHLAKE PHYSICIAN PRACTICE NETWORK, INC.

Active
Other names
Women's Cancer Alliance
Organization subpart
No

Provider details

NPI number
Authorized official
MARK PICKETT (VP)
(770) 938-3440
Entity
Organization

Contact information

Practice address
1459 MONTREAL RD, SUITE 408, TUCKER, GA 30084-6900
(770) 938-3440
Mailing address
1459 MONTREAL RD, SUITE 408, TUCKER, GA 30084-6900
(770) 938-3440

Taxonomy

Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary

Other

Enumeration date
07/05/2006
Last updated
08/29/2007
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