Provider Demographics
NPI:1619150232
Name:NORTHERN PROFESSIONAL CENTER INC
Entity Type:Organization
Organization Name:NORTHERN PROFESSIONAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-322-3374
Mailing Address - Street 1:2295 TOWNE LAKE PKWY
Mailing Address - Street 2:SUITE 116-142
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5520
Mailing Address - Country:US
Mailing Address - Phone:912-322-3374
Mailing Address - Fax:
Practice Address - Street 1:2295 TOWNE LAKE PKWY
Practice Address - Street 2:SUITE 116-142
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5520
Practice Address - Country:US
Practice Address - Phone:912-322-3374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty