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General NPI Number Information
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NPI Number | 1245193358
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Entity Type | Organization
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Legal Business Name | NORTHSIDE WOMENS GROUP LLC
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 460 NORTHSIDE CHEROKEE BLVD STE 360
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City | CANTON
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State | GA
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Zip | 30115-8019
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Country | US
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Telephone | 770-255-2550
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 JOHNSON FY RD NE
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City | ATLANTA
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State | GA
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Zip | 30342-1606
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP ADMIN SVCS/CCO
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Name | JORGE J. HERNANDEZ
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Credential |
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Telephone | 404-851-6378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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