Provider Demographics
NPI:1346701216
Name:LAKEWOOD MEDICAL
Entity Type:Organization
Organization Name:LAKEWOOD MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:RASHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAAITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-702-7225
Mailing Address - Street 1:2891 LAKEWOOD AVE SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-5803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2891 LAKEWOOD AVE SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-5803
Practice Address - Country:US
Practice Address - Phone:678-927-9996
Practice Address - Fax:404-835-2872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care