Northside Urgent Care Holding, LLC

Key facts

NPI

1295124147

Entity type

Organization (NPI type 2)

Primary specialty

Family Medicine Physician 207Q00000X

Legal business name

NORTHSIDE URGENT CARE HOLDING, LLC

Practice address

1000 Johnson Fy Rd NE
Atlanta, GA 30342-1606

Phone

(404) 851-8809

NPI assigned

Jan 15, 2015

Organization subpart

No

Authorized official

Name

Jorge J. Hernandez

Title

VP OD Admin Services and Cco

Phone

(404) 851-6378

National Provider Directory

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 15, 2015.

{
    "created_epoch": "1421280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421280000000",
    "number": "1295124147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FY RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FY RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421606",
            "telephone_number": "404-851-8809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE URGENT CARE HOLDING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-15",
        "last_updated": "2015-01-15",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "JORGE",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "VP OD ADMIN SERVICES AND CCO",
        "authorized_official_telephone_number": "404-851-6378"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Atlanta, GA · Family Medicine Physician in Georgia