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General NPI Number Information
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NPI Number | 1437361375
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Entity Type | Organization
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Legal Business Name | NORTHLAKE WOMEN'S SPECIALISTS
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 2183 NORTHLAKE PKWY SUITE 102
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City | TUCKER
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State | GA
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Zip | 30084-4108
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Country | US
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Telephone | 770-934-6464
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Fax | 770-934-4577
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Provider Business Mailing Address
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Address Line | 2183 NORTHLAKE PKWY SUITE 102
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City | TUCKER
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State | GA
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Zip | 30084-4108
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Country | US
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Telephone | 770-934-6464
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Fax | 770-934-4577
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Authorized Official
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Title or Position | MEMBER
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Name | DR. CHENG LING YU
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Credential | M.D.
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Telephone | 770-934-6464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State | GA
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