Healthcare Provider Details

I. General information

NPI: 1134168016
Provider Name (Legal Business Name): NORTHSIDE HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 MCCLURE BRIDGE RD
DULUTH GA
30096-3223
US

IV. Provider business mailing address

1000 JOHNSON FERRY ROAD, NE ATTN: JORGE HERNANDEZ
ATLANTA GA
30342
US

V. Phone/Fax

Practice location:
  • Phone: 678-312-6000
  • Fax: 678-312-6015
Mailing address:
  • Phone: 404-851-6378
  • Fax: 678-312-6015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number067-628
License Number StateGA

VIII. Authorized Official

Name: MR. JORGE HERNANDEZ
Title or Position: VP AMIN, CCO
Credential:
Phone: 404-851-6378