Provider Demographics
NPI:1881830263
Name:NORTHWOODS CLINIC LLC
Entity Type:Organization
Organization Name:NORTHWOODS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-667-7600
Mailing Address - Street 1:11180 STATE BRIDGE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7482
Mailing Address - Country:US
Mailing Address - Phone:770-667-7600
Mailing Address - Fax:770-667-7660
Practice Address - Street 1:11180 STATE BRIDGE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-7482
Practice Address - Country:US
Practice Address - Phone:770-667-7600
Practice Address - Fax:770-667-7660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty