Provider Demographics
NPI:1689414757
Name:NORTHLAND MEDICAL LLC
Entity type:Organization
Organization Name:NORTHLAND MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LAZARUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-709-2103
Mailing Address - Street 1:270 CARPENTER DR STE 515
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4949
Mailing Address - Country:US
Mailing Address - Phone:404-803-0573
Mailing Address - Fax:
Practice Address - Street 1:270 CARPENTER DR STE 515
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4949
Practice Address - Country:US
Practice Address - Phone:404-803-0573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-28
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)