Provider Demographics
NPI:1891430583
Name:LAKESIDE NORTH FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:LAKESIDE NORTH FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CLAY
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-571-8460
Mailing Address - Street 1:38 ROWE DR
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-7367
Mailing Address - Country:US
Mailing Address - Phone:256-571-8460
Mailing Address - Fax:256-571-8464
Practice Address - Street 1:38 ROWE DR
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-7367
Practice Address - Country:US
Practice Address - Phone:256-571-8460
Practice Address - Fax:256-571-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health