Basic Information
| Provider Information | |||||||||
| NPI: | 1528618220 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHLAKE URGENT CARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135 TAMARISK DR | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043101123 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4060 LAVISTA RD | ||||||||
| Address2: | |||||||||
| City: | TUCKER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300845216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042371755 | ||||||||
| FaxNumber: | 4042371764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2019 | ||||||||
| LastUpdateDate: | 09/13/2019 | ||||||||
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| AuthorizedOfficialLastName: | WALKER | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
| AuthorizedOfficialMiddleName: | LATANYA | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4043101123 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.