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General NPI Number Information
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NPI Number | 1790715381
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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 | 07/03/2006
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 3620 HOWELL FERRY RD
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City | DULUTH
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State | GA
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Zip | 30096-3178
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Country | US
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Telephone | 678-312-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 JOHNSON FERRY ROAD, NE ATTN: JORGE HERNANDEZ
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City | ATLANTA
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State | GA
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Zip | 30342
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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 ADMIN; CCO
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Name | MR. JORGE 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 | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 067-628
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License Number State | GA
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