Provider Demographics
NPI:1437361375
Name:NORTHLAKE WOMEN'S SPECIALISTS
Entity Type:Organization
Organization Name:NORTHLAKE WOMEN'S SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHENG
Authorized Official - Middle Name:LING
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-934-6464
Mailing Address - Street 1:2183 NORTHLAKE PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4108
Mailing Address - Country:US
Mailing Address - Phone:770-934-6464
Mailing Address - Fax:770-934-4577
Practice Address - Street 1:2183 NORTHLAKE PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4108
Practice Address - Country:US
Practice Address - Phone:770-934-6464
Practice Address - Fax:770-934-4577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1415Medicare ID - Type Unspecified