Organization
NORTHSIDE HOSPITAL, INC.
Active
Other names
Diagnostic Clinic Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JORGE J. HERNANDEZ (VP ADMIN SRVS/CCO)
(404) 851-6378
Entity
Organization
Contact information
Practice address
1240 JESSE JEWELL PKWY SE STE 550, GAINESVILLE, GA 30501-3863
(678) 450-7855
Mailing address
1000 JOHNSON FY RD NE, ATLANTA, GA 30342-1606
(404) 851-6378
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
PHRE009913
GA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
04/24/2013
Last updated
10/25/2018
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