Provider Demographics
NPI:1598843872
Name:NORTHSIDE OB/GYN, P.C.
Entity Type:Organization
Organization Name:NORTHSIDE OB/GYN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:JOFFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-256-2811
Mailing Address - Street 1:993 JOHNSON FERRY RD NE
Mailing Address - Street 2:BLDG. C SUITE 120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1620
Mailing Address - Country:US
Mailing Address - Phone:404-256-2811
Mailing Address - Fax:404-257-9855
Practice Address - Street 1:993 JOHNSON FERRY RD NE
Practice Address - Street 2:BLDG. C SUITE 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1620
Practice Address - Country:US
Practice Address - Phone:404-256-2811
Practice Address - Fax:404-257-9855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021164174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty