NORTHSIDE CV PROFESSIONAL SERVICES LLC NPI 1821612938

NPI Information

NORTHSIDE CV PROFESSIONAL SERVICES LLC is a cardiovascular disease internal medicine in Lawrenceville, GA. The provider is an internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. NORTHSIDE CV PROFESSIONAL SERVICES LLC NPI is 1821612938. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

755 WALTHER RD
LAWRENCEVILLE, GA
ZIP 30046-725
Phone: (770) 962-0399

The provider's authorized official is Jorge J Hernandez .
The authorized official title is Vp Admin. Svc./cco and has the following contact phone number (404) 851-6378.

The CLIA number assigned to this NPI record is 11D2139931 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/4/2020 and was last updated on 8/12/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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