| Organization Name: | NORTHSIDE IMAGING LLC |
| NPI Number: | 1003295403 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JORGE J. HERNANDEZ (VP-ADMIN, CCO) |
| Mailing Address: | 845 Prince Ave Athens |
| State: | GA US |
| Postal Code: | 306062723 |
| Phone Number: | 7065491118 |
| Fax Number: | |
| NPI Enumeration Date: | 05/19/2015 |
| NPI Last Update Date: | 05/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Radiology |
| Taxonomy Definition: | |