Provider Demographics
NPI:1396051447
Name:LAKESIDE NORTH, LLC
Entity type:Organization
Organization Name:LAKESIDE NORTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-571-8460
Mailing Address - Street 1:7938 AL HIGHWAY 69
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-7134
Mailing Address - Country:US
Mailing Address - Phone:256-571-8460
Mailing Address - Fax:256-571-8464
Practice Address - Street 1:7938 AL HIGHWAY 69
Practice Address - Street 2:SUITE 130
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-7134
Practice Address - Country:US
Practice Address - Phone:256-571-8460
Practice Address - Fax:256-571-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty