Organization Name: | NORTHSIDE PRIMARY CARE PROFESSIONAL SERVICES, LLC |
NPI Number: | 1215369715 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JORGE J. HERNANDEZ (VP-ADMIN, CCO) |
Mailing Address: | 81 Northside Dawson Drive Dawsonville |
State: | GA US |
Postal Code: | 305347166 |
Phone Number: | 7062166000 |
Fax Number: | |
NPI Enumeration Date: | 08/07/2013 |
NPI Last Update Date: | 08/07/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | GA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |