Healthcare Provider Details

I. General information

NPI: 1598673758
Provider Name (Legal Business Name): NORTHSIDE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 NORTHSIDE CHEROKEE BLVD
CANTON GA
30115-8015
US

IV. Provider business mailing address

1000 JOHNSON FERRY RD
SANDY SPRINGS GA
30342-1611
US

V. Phone/Fax

Practice location:
  • Phone: 770-224-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: AQUILES DUERO III
Title or Position: RN
Credential: RN
Phone: 770-224-2000