Organization
NORTHSIDE CV PROFESSIONAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORGE J HERNANDEZ (VP ADMIN. SVC./CCO)
(404) 851-6378
Entity
Organization
Contact information
Practice address
755 WALTHER RD, LAWRENCEVILLE, GA 30046-8725
(770) 962-0399
Mailing address
1001 SUMMIT BLVD STE 1000, BROOKHAVEN, GA 30319-6415
(404) 851-6378
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Enumeration date
06/04/2020
Last updated
06/02/2025
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