Healthcare Provider Details

I. General information

NPI: 1679962237
Provider Name (Legal Business Name): NORTHSIDE URGENT CARE HOLDING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FY RD NE
ATLANTA GA
30342-1606
US

IV. Provider business mailing address

1000 JOHNSON FY RD NE
ATLANTA GA
30342-1606
US

V. Phone/Fax

Practice location:
  • Phone: 855-709-4535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: AMY E FOUTS
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 404-851-6968