Healthcare Provider Details

I. General information

NPI: 1932381233
Provider Name (Legal Business Name): TOWNE LAKE INTERNAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WYNGATE PKWY STE 210
WOODSTOCK GA
30189-6981
US

IV. Provider business mailing address

1000 WYNGATE PKWY STE 210
WOODSTOCK GA
30189-6981
US

V. Phone/Fax

Practice location:
  • Phone: 770-928-3132
  • Fax: 770-928-9109
Mailing address:
  • Phone: 770-928-3132
  • Fax: 770-928-9109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: DR. HILARY THOMAS HIGHT III
Title or Position: INTERNIST
Credential: MD
Phone: 770-928-3132