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General NPI Number Information
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NPI Number | 1770506966
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Entity Type | Organization
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Legal Business Name | NORTHSIDE RESPIRATORY CARE
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 5505 PEACHTREE DUNWOODY RD NE SUITE 370
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City | ATLANTA
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State | GA
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Zip | 30342-1705
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Country | US
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Telephone | 404-257-0006
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Fax | 678-510-0018
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Provider Business Mailing Address
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Address Line | 5505 PEACHTREE DUNWOODY RD NE SUITE 370
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City | ATLANTA
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State | GA
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Zip | 30342-1705
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Country | US
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Telephone | 404-257-0006
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Fax | 678-510-0018
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHANIE EATON
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Credential | M.D.
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Telephone | 404-257-0006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | GA
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