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NPI Code Detail

MEDICARE: TOWNE LAKE INTERNAL MEDICINE, LLC

MEDICARE: TOWNE LAKE INTERNAL MEDICINE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1173000000XLegal Medicine

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DC0831OTHERGARR MEDICARE

General Provider Information

NPI Number : 1932381233
Entity Type Code : Organization
Provider Name (Legal Business Name) : TOWNE LAKE INTERNAL MEDICINE, LLC
Provider Business Mailing Address
First Line : 1000 WYNGATE PKWY
Second Line : STE 210
City : WOODSTOCK
State : GA
Zip : 30189-6981
Country : US
Telephone Number : 770-928-3132
Fax Number : 770-928-9109
Provider Business Practice Location Address
First Line : 1000 WYNGATE PKWY
Second Line : STE 210
City : WOODSTOCK
State : GA
Zip : 30189-6981
Country : US
Telephone Number : 770-928-3132
Fax Number : 770-928-9109
Authorized Official
Title or Position : INTERNIST
Name : DR. HILARY THOMAS HIGHT III
Credential : MD
Telephone Number : 770-928-3132
Provider Enumeration Date : 11/29/2007
Last Update Date : 11/12/2015

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Directions to “TOWNE LAKE INTERNAL MEDICINE, LLC ” Practice Location

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