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General NPI Number Information
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NPI Number | 1386062255
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Entity Type | Organization
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Legal Business Name | NORTHSIDE HOSPITAL, INC.
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Dates
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Enumeration Date | 03/28/2014
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Last Update Date | 03/28/2014
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Provider Practice Location Address
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Address Line | 4553 N SHALLOWFORD RD STE. 60-C
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City | ATLANTA
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State | GA
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Zip | 30338-6408
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Country | US
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Telephone | 770-455-1983
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Fax | 770-457-2823
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Provider Business Mailing Address
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Address Line | 1100 JOHNSON FERRY RD CENTERPOINTE II, STE 920
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City | ATLANTA
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State | GA
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Zip | 30342-1709
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Country | US
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Telephone | 404-851-6378
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Fax |
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Authorized Official
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Title or Position | VP/CHIEF COMPLIANCE OFFICER
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Name | MR. 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 | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 044-281
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License Number State | GA
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