Lakeside Family Medicine
Clinic/Center, Primary Care in Gainesville, GA. Organization (NPI-2).
NPI number1720514029
StatusActive
Last updated in NPPESMay 4, 2017
Details
- NPI
- 1720514029
- Entity type
- Organization (NPI-2)
- Legal business name
- Lakeside Family Medicine
- Organization subpart
- No
- Enumeration date
- May 4, 2017
- Last updated
- May 4, 2017
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP2300X | Clinic/Center, Primary Care | F0514016 | GA | Yes |
Practice location
104 Carrington Park Dr Ste BGainesville, GA 30504-6603
Phone 770-899-3773
Mailing address
104 Carrington Park Dr Ste BGainesville, GA 30504-6603
Phone 770-899-3773
Authorized official
Foroogh Narmani-Mohammadi
Family Nurse Practitioner
7708993773
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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