Organization Name: | NORTHSIDE IMAGING LLC |
NPI Number: | 1407235815 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JORGE J. HERNANDEZ (VP-ADMIN, CCO) |
Mailing Address: | 638 441 Historic Hwy N Suite D Demorest |
State: | GA US |
Postal Code: | 305354574 |
Phone Number: | 7064549900 |
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: |