Healthcare Provider Details

I. General information

NPI: 1740515618
Provider Name (Legal Business Name): NORTHSIDE CHEROKEE URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2009
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PEACHTREE ST NE NORTH TOWER, SUITE 2100
ATLANTA GA
30303-1401
US

IV. Provider business mailing address

235 PEACHTREE ST NE NORTH TOWER, SUITE 2100
ATLANTA GA
30303-1401
US

V. Phone/Fax

Practice location:
  • Phone: 770-994-9326
  • Fax: 770-994-4747
Mailing address:
  • Phone: 770-994-9326
  • Fax: 770-994-4747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL DOW BOURLAND
Title or Position: PRESIDENT & CEO
Credential: MD
Phone: 770-994-9326