| Organization Name: | NORTHSIDE URGENT CARE HOLDING, LLC |
| NPI Number: | 1679962237 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JORGE J. HERNANDEZ (VP OF ADMIN SERVICES AND CCO) |
| Mailing Address: | 1000 Johnson Fy Rd Ne Atlanta |
| State: | GA US |
| Postal Code: | 303421606 |
| Phone Number: | 4048518000 |
| Fax Number: | |
| NPI Enumeration Date: | 01/20/2015 |
| NPI Last Update Date: | 10/22/2015 |
| 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: | |