# NORTHSIDE HOSPITAL, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Northside Gwinnett Extended Care Center Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437134970
- **Authorized official:** JUDY GARDNER PHARMD, FASHP (DIRECTOR, PHARMACEUTICAL SERVICES)
- **Authorized official phone:** (404) 851-6793

## Contact information

- **Practice address:** 650 PROFESSIONAL DR, LAWRENCEVILLE, GA 30046-8707
- **Practice address phone:** (678) 442-3642
- **Practice address fax:** (770) 442-3066
- **Mailing address:** 1000 JOHNSON FERRY ROAD, ATTN: JUDY GARDNER, ATLANTA, GA 30342-1616
- **Mailing address phone:** (404) 851-6793
- **Mailing address fax:** (404) 851-8610

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | PHRE008388 | GA | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 12/07/2005
- **Last updated:** 11/10/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1147215 | NABP OR NCPDP | GA |
| 05 | — | 866291A | — | GA |