Provider Demographics
NPI:1265664791
Name:NORTHSIDE ACUPUNCTURE
Entity Type:Organization
Organization Name:NORTHSIDE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENGAOUT
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:404-849-8805
Mailing Address - Street 1:415 SABLE CT
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-8013
Mailing Address - Country:US
Mailing Address - Phone:404-849-8805
Mailing Address - Fax:678-393-2947
Practice Address - Street 1:500 BISHOP ST NW
Practice Address - Street 2:SUITE F-7
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-4366
Practice Address - Country:US
Practice Address - Phone:404-849-8805
Practice Address - Fax:678-393-2947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAG228171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty