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General NPI Number Information
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NPI Number | 1922131770
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Entity Type | Organization
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Legal Business Name | NORTHSIDE WOMENS CLINIC INC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3543 CHAMBLEE DUNWOODY ROAD
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City | ATLANTA
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State | GA
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Zip | 30341-2454
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Country | US
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Telephone | 770-455-4210
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Fax | 770-451-9529
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Provider Business Mailing Address
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Address Line | 3543 CHAMBLEE DUNWOODY ROAD
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City | ATLANTA
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State | GA
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Zip | 30341-2454
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Country | US
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Telephone | 770-455-4210
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Fax | 770-451-9529
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | MS. LORRI E GAY
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Credential |
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Telephone | 770-455-4210
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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 | 044023
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License Number State | GA
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