Healthcare Provider Details

I. General information

NPI: 1508914995
Provider Name (Legal Business Name): LAKEWOOD HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 JONESBORO ROAD SE
ATLANTA GA
30315
US

IV. Provider business mailing address

99 JESSE HILL JR DRIVE RM 402
ATLANTA GA
30303
US

V. Phone/Fax

Practice location:
  • Phone: 404-624-0626
  • Fax: 404-624-0636
Mailing address:
  • Phone: 404-730-1217
  • Fax: 404-730-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: STEVEN R KATKOWSKY
Title or Position: HEALTH DIRECTOR
Credential: MD
Phone: 404-730-1202