Organization
NORTHSIDE HOSPITAL, INC.
Active
Other names
Northside Gwinnett Joan Glancy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JORGE HERNANDEZ (VP AMIN, CCO)
(404) 851-6378
Entity
Organization
Contact information
Practice address
3215 MCCLURE BRIDGE RD, DULUTH, GA 30096-3223
(678) 312-6000
(678) 312-6015
Mailing address
1000 JOHNSON FERRY ROAD, NE, ATTN: JORGE HERNANDEZ, ATLANTA, GA 30342
(404) 851-6378
(678) 312-6015
Taxonomy
Speciality
Code
Description
License number
State
273Y00000X
Rehabilitation Hospital Unit
Primary
067-628
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1064A
—
GA
Enumeration date
06/06/2006
Last updated
05/07/2025
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