1437134970 NPI number — NORTHSIDE HOSPITAL, INC.

Table of content: (NPI 1437134970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437134970 NPI number — NORTHSIDE HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHSIDE HOSPITAL, INC.
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:
1437134970
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 JOHNSON FERRY ROAD
Provider Second Line Business Mailing Address:
ATTN: JUDY GARDNER
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30342-1616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-851-6793
Provider Business Mailing Address Fax Number:
404-851-8610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 PROFESSIONAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30046-8707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-442-3642
Provider Business Practice Location Address Fax Number:
770-442-3066
Provider Enumeration Date:
12/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GARDNER
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, PHARMACEUTICAL SERVICES
Authorized Official Telephone Number:
404-851-6793

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  PHRE008388 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1147215 . This is a "NABP OR NCPDP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 866291A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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