Provider Demographics
NPI:1184394058
Name:NORTHSIDE HOSPITAL, INC.
Entity type:Organization
Organization Name:NORTHSIDE HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SYSTEM DIRECTOR, PHARMACEUTICAL SER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-851-6793
Mailing Address - Street 1:1000 JOHNSON FERRY RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-851-8000
Mailing Address - Fax:770-393-0835
Practice Address - Street 1:1110 W PEACHTREE STREET NW
Practice Address - Street 2:SUITE 340
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3609
Practice Address - Country:US
Practice Address - Phone:678-792-4110
Practice Address - Fax:404-343-4635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy