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General NPI Number Information
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NPI Number | 1437134970
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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 | 12/07/2005
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 650 PROFESSIONAL DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8707
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Country | US
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Telephone | 678-442-3642
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Fax | 770-442-3066
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Provider Business Mailing Address
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Address Line | 1000 JOHNSON FERRY ROAD ATTN: JUDY GARDNER
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City | ATLANTA
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State | GA
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Zip | 30342-1616
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Country | US
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Telephone | 404-851-6793
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Fax | 404-851-8610
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Authorized Official
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Title or Position | DIRECTOR, PHARMACEUTICAL SERVICES
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Name | JUDY GARDNER
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Credential | PHARMD, FASHP
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Telephone | 404-851-6793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | PHRE008388
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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