# EVERSIDE HEALTH, LLC

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

## Provider details

- **NPI number:** 1639636988
- **Authorized official:** JILL JOHNSON PATTON (DIRECTOR OF RISK MANAGEMENT)
- **Authorized official phone:** (704) 936-5546

## Contact information

- **Practice address:** 9720 PARK PLAZA AVE UNIT 101, LOUISVILLE, KY 40241-2289
- **Practice address phone:** (502) 410-5788
- **Practice address fax:** (978) 620-2349
- **Mailing address:** 4651 CHARLOTTE PARK DR STE 300, CHARLOTTE, NC 28217-1916

## Taxonomy

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

## Other

- **Enumeration date:** 02/22/2019
- **Last updated:** 08/11/2022