NORTHLAKE SURGICAL CENTER, LP (NPI# 1124083787) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124083787 |
| Entity Type | Organization |
| Organization Name | NORTHLAKE SURGICAL CENTER, LP |
| Practice Address |
1491 Montreal Rd Tucker GA 30084-6922 |
| Practice Telephone | 7702701284 |
| Practice Fax Number | 7702705279 |
| Mailing Telephone | 7702701284 |
| Mailing Fax Number | 7702705279 |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2018-02-15 |
| Authorized Official Name | WILLIAM GREGORY SWINNEY (VP) |
| Authorized Official Telephone | 9727892877 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
044170 | GA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 00769601A | 05 |
| Street Address |
1491 MONTREAL RD |
| City | TUCKER |
| State | GA |
| Zip Code | 30084-6922 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114964996 | Michael L Werner | Physician Assistant | 1491 Montreal Rd, Tucker, GA 30084-6922 | 2006-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609401355 | Excellent Medical Transport | Ambulance | 4378 Sentry Dr, Tucker, GA 30084 | 2020-03-03 |
| 1811468796 | Caleb Lee Ebbets | Physical Therapist | 1459 Montreal Road, Medical Office Building, Suite 301, Tucker, GA 30084 | 2018-12-17 |
| 1417436130 | Benjamin Han Wook Chong | Physical Therapist | 1460 Montreal Road East, Suite 300, Tucker, GA 30084 | 2018-08-13 |
| 1336659325 | Lavista Acupuncture and Herbal Medicine | Acupuncturist | 4915 Lavista Rd, Tucker, GA 30084 | 2017-10-04 |
| 1699294207 | Debrica Butler | Counselor | 1021 Oak Chase Dr., Apt C, Tucker, GA 30084 | 2017-09-14 |
| 1295264695 | Jolanta Wazgowska Hopkins | Social Worker | 4404 Idlewood Lane, Tucker, GA 30084 | 2017-06-08 |
| 1164956157 | Sage Dental Group of Georgia LLC | Dentist | 4320 Lavista Rd, Suite C119, Tucker, GA 30084 | 2017-04-17 |
| 1689107807 | Mashail Manzur | Podiatrist | 1460 Montreal Rd E, Ste 275, Tucker, GA 30084 | 2017-04-05 |
| 1053765578 | Jessica Spruyt | Speech-Language Pathologist | 3756 Lavista Rd Suite 104, Tucker, GA 30084 | 2016-04-21 |
| 1265802318 | Spine and Orthopedics of Atlanta, LLC | Clinic/Center | 1462 Montreal Rd Ste 218, Tucker, GA 30084 | 2015-10-01 |
| Find all providers in zip 30084 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205229192 | Advanced Orthopedic Surgery Center LLC | Clinic/Center | 1462 Montreal Rd, Suite 109, Tucker, GA 30084-6929 | 2015-03-17 |
| 1871594499 | Northlake Endoscopy Center | Clinic/Center | 1459 Montreal Rd, Su 204, Tucker, GA 30084-6900 | 2005-08-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
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| 1518579903 | Amin Surgery Center for Women LLC | Clinic/Center | 1150b Kirkland Ln, Douglas, GA 31533-2044 | 2020-08-18 |
| 1801413174 | Pa-c Surgical Assist, LLC | Clinic/Center | 520 W Ponce Leon Ave #1706, Decatur, GA 30030 | 2020-07-02 |
| 1720602683 | Georgia Eye Surgery LLC | Clinic/Center | 1620 Prince Ave Ste B, Athens, GA 30606-6008 | 2020-06-05 |
| 1750905618 | Rsps Fayetteville Asc Lllp | Clinic/Center | 874 Lanier Ave W Ste 270, Fayetteville, GA 30214-7617 | 2020-06-05 |
| 1699395541 | Medici Surgical Center Gwinnett, LLC | Clinic/Center | 2220 Wisteria Dr Ste 100, Snellville, GA 30078-4604 | 2020-04-21 |
| 1114552338 | Georgia Interventional Pain - G, LLC | Clinic/Center | 1504 N Thornton Ave Ste 104, Dalton, GA 30720-8394 | 2020-03-09 |
| 1700424322 | Georgia Interventional Pain - F, LLC | Clinic/Center | 1357 Hembree Rd Ste 230, Roswell, GA 30076-5725 | 2019-12-13 |
| 1699328369 | Georgia Urology, Pa | Clinic/Center | 1670 Scott Blvd Ste 204k, Decatur, GA 30033-5645 | 2019-07-22 |
| 1912563941 | Commerce Ambulatory Surgery Center, Inc. | Clinic/Center | 417 Pottery Factory Dr, Commerce, GA 30529-6682 | 2019-05-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.