Northside Hospital, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

067-460 Issued in GA

Legal business name

NORTHSIDE HOSPITAL, INC.

Doing business as

Northside Gwinnett Extended Care Center

Practice address

650 Professional Dr
Lawrenceville, GA 30046-8707

Phone

(678) 312-3000

Fax

(678) 312-3065

NPI assigned

Jun 14, 2006

Last updated

Sep 18, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jorge Hernandez

Title

VP Admin; Cco

Phone

(404) 851-6378

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Northside Gwinnett Extended Care Center Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Northside Hospital, Inc.

  dba Diagnostic Clinic Oncology Pharmacy

  • Community/Retail Pharmacy
  • Gainesville, GA
  • NPI 1326679150

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568764800000",
    "number": "1396788428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FERRY ROAD, NE",
            "address_2": "ATTN: JORGE HERNANDEZ",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30342",
            "telephone_number": "404-851-6378",
            "fax_number": "678-312-3065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 PROFESSIONAL DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468707",
            "telephone_number": "678-312-3000",
            "fax_number": "678-312-3065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2019-09-18",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "JORGE",
        "authorized_official_title_or_position": "VP ADMIN; CCO",
        "authorized_official_telephone_number": "404-851-6378",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "067-460",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "781382A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northside Gwinnett Extended Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Northeast Endoscopy Center, LLC
• Northeast Georgia Mental Health Services, LLC
• Northeast Infectious Diseases Inc
• Northside CV Professional Services LLC
• Northside Hospital Inc (Northside Hospital Gwinnett Outpatient Pharmacy)
• Northside Hospital, Inc. (Northside Gwinnett Extended Care Center Pharmacy)
• Northside Hospital, Inc. (Suburban Oncology Pharmacy)
• Northside Hospital, Inc. (Northside Hospital Gwinnett)
• Northside WGG LLC
• Northside Womens Group LLC (Northside WGG)

• Skilled Nursing Facility in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Skilled Nursing Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.