Provider Demographics
NPI:1952818908
Name:NORTHSIDE URGENT CARE CENTERS
Entity Type:Organization
Organization Name:NORTHSIDE URGENT CARE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-797-0274
Mailing Address - Street 1:3367 BUFORD HWY NE STE 910
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30329-1833
Mailing Address - Country:US
Mailing Address - Phone:470-440-5864
Mailing Address - Fax:
Practice Address - Street 1:3367 BUFORD HWY NE STE 910
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-1833
Practice Address - Country:US
Practice Address - Phone:470-440-5864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care