Organization
NORTHSIDE HOSPITAL, INC.
Active
Other names
Northside Gwinnett Extended Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JORGE HERNANDEZ (VP ADMIN; CCO)
(404) 851-6378
Entity
Organization
Contact information
Practice address
650 PROFESSIONAL DR, LAWRENCEVILLE, GA 30046-8707
(678) 312-3000
(678) 312-3065
Mailing address
1000 JOHNSON FERRY ROAD, NE, ATTN: JORGE HERNANDEZ, ATLANTA, GA 30342
(404) 851-6378
(678) 312-3065
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
067-460
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
781382A
—
GA
Enumeration date
06/14/2006
Last updated
09/18/2019
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