| Organization Name: | NORTHLAKE SURGICAL CENTER, LP |
| NPI Number: | 1124083787 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DON LIEDTKE (VICE PRESIDENT) |
| Mailing Address: | 1491 Montreal Rd Tucker |
| State: | GA US |
| Postal Code: | 300846922 |
| Phone Number: | 7702701284 |
| Fax Number: | 7702705279 |
| NPI Enumeration Date: | 04/18/2006 |
| NPI Last Update Date: | 10/12/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 044170 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |