# NORTHSIDE URGENT CARE HOLDING, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295124147
- **Authorized official:** JORGE J. HERNANDEZ (VP OD ADMIN SERVICES AND CCO)
- **Authorized official phone:** (404) 851-6378

## Contact information

- **Practice address:** 1000 JOHNSON FY RD NE, ATLANTA, GA 30342-1606
- **Practice address phone:** (404) 851-8809
- **Mailing address:** 1000 JOHNSON FY RD NE, ATLANTA, GA 30342-1606

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | GA | Yes |

## Other

- **Enumeration date:** 01/15/2015
- **Last updated:** 01/15/2015