MEDICARE: NORTHSIDE RADIOLOGY ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2085R0204X	Vascular & Interventional Radiology Physician
2	2085N0700X	Neuroradiology Physician
3	2085N0904X	Nuclear Radiology Physician
4	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013960657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSIDE RADIOLOGY ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	PO BOX 85382
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60689-5500
Country	:	US
Telephone Number	:	678-553-7784
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 JOHNSON FERRY RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1606
Country	:	US
Telephone Number	:	404-662-2438
Fax Number	:

Authorized Official
Title or Position	:	AO
Name	:	KAREN MARIE VAUGHN
Credential	:
Telephone Number	:	629-317-1465

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	03/26/2026

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