Organization
NORTHLAKE ENDOSCOPY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RALPH ROBERT BETON MD (PRESIDENT)
(770) 939-4721
Entity
Organization
Contact information
Practice address
1459 MONTREAL RD, SU 204, TUCKER, GA 30084-6900
(770) 939-4721
(770) 939-1187
Mailing address
1459 MONTREAL RD, SU 204, TUCKER, GA 30084-6900
(770) 939-4721
(770) 939-1187
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
044047
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000468652A
—
GA
Enumeration date
08/04/2005
Last updated
05/08/2008
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