Healthcare Provider Details

I. General information

NPI: 1346701216
Provider Name (Legal Business Name): LAKEWOOD MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2891 LAKEWOOD AVE SW
ATLANTA GA
30315-5803
US

IV. Provider business mailing address

2891 LAKEWOOD AVE SW
ATLANTA GA
30315-5803
US

V. Phone/Fax

Practice location:
  • Phone: 678-927-9996
  • Fax: 404-835-2872
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RASHAWN BAAITH
Title or Position: COO
Credential:
Phone: 404-702-7225