Organization
NORTHSIDE NAMA PROFESSIONAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JORGE HERNANDEZ (CCO)
(404) 851-6378
Entity
Organization
Contact information
Practice address
2545 LAWRENCEVILLE HWY STE 200, DECATUR, GA 30033-3240
(770) 934-7876
Mailing address
1000 JOHNSON FERRY ROAD, NE, ATTN: JORGE HERNANDEZ, ATLANTA, GA 30342
(404) 851-6379
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Enumeration date
08/01/2019
Last updated
08/01/2019
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