1861123580 NPI number — MARIETTA NORTHSIDE HOSPITAL SERVICES CORP

Table of content: WILLIAM ALEXANDER JOHNSON PA (NPI 1821570987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861123580 NPI number — MARIETTA NORTHSIDE HOSPITAL SERVICES CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIETTA NORTHSIDE HOSPITAL SERVICES CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861123580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4800 OLDE TOWNE PKWY STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30068-4378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-721-2432
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 OLDE TOWNE PKWY STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30068-4378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-721-2432
Provider Business Practice Location Address Fax Number:
717-307-3540
Provider Enumeration Date:
06/22/2022

Additional Information

Authorized Official

Authorized Official Last Name:
TANVEER
Authorized Official First Name:
HAMZA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
404-721-2432

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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