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LAKESIDE FAMILY MEDICINE
NPI 1720514029
Clinic/Center - Primary Care in Gainesville, GA

Active since May 04, 2017CLIA 11D2135806 · Waiver
104 CARRINGTON PARK DR STE B, GAINESVILLE, GA 30504(770) 899-3773 Get Directions Write a Review

NPPES record last updated: May 4, 2017. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Lakeside Family Medicine NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKESIDE FAMILY MEDICINE (NPI 1720514029) is a healthcare organization registered as a primary care in Gainesville, Georgia and active in the NPI registry since May 2017. The organization holds a CLIA Waiver certificate valid through August 28, 2027 and lists Foroogh Narmani-mohammadi, Family Nurse Practitioner, as its authorized official.

NPPES Registry Identity

NPI1720514029
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameLAKESIDE FAMILY MEDICINE
Location Address104 CARRINGTON PARK DR STE BGainesville, GA 30504-6603
Mailing Address104 Carrington Park Dr Ste BGainesville, GA 30504-6603 · (770) 899-3773
Phone(770) 899-3773
Organization SubpartNo
Authorized OfficialForoogh Narmani-mohammadiFamily Nurse Practitioner · (770) 899-3773
Enumeration DateMay 4, 2017
✔ NPI 1720514029 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
License✔ Licensed in GA · F0514016
104 CARRINGTON PARK DR STE B, Gainesville, GA 30504
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2135806

Lakeside Family Medicine · Gainesville, GA
Active · expires Aug 28, 2027
CLIA Number11D2135806
Laboratory TypeAncillary Testing Site In Health Care Center
Certificate Effective DateAugust 29, 2025
Certificate Expiration DateAugust 28, 2027
Laboratory DirectorForoogh Narmani-Muhummudi
Laboratory Phone(470) 252-5933
Laboratory LocationLakeside Family Medicine104 Carrington Park Drive, Suite B, Gainesville, GA 30504
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FOROOGH NARMANI-MOHAMMADI DNP, FNP-C
Nurse Practitioner (Family)
104 CARRINGTON PARK DR STE B
GAINESVILLE, GA 30504
Hall County (470) 252-5933

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lakeside Family Medicine's NPI number?

The NPI number for Lakeside Family Medicine is 1720514029. It was assigned to this organization in the NPPES registry on May 4, 2017.

Where is Lakeside Family Medicine located?

Lakeside Family Medicine is located at 104 Carrington Park Dr Ste B, Gainesville, GA 30504. The listed phone number is (770) 899-3773.

What is Lakeside Family Medicine's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Lakeside Family Medicine hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2135806) is associated with this NPI, valid through August 28, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lakeside Family Medicine was last updated on May 4, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.