| Northside Urgent Care Holding, Llc | |
|
1000 Johnson Fy Rd Ne Atlanta GA 30342-1606 | |
| (855) 709-4535 | |
| Not Available |
| Full Name | Northside Urgent Care Holding, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1000 Johnson Fy Rd Ne, Atlanta, Georgia |
| Authorized Official Name and Position | Jorge J. Hernandez (VP OF ADMIN SERVICES AND CCO) |
| Authorized Official Contact | 4048516378 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northside Urgent Care Holding, Llc 1000 Johnson Fy Rd Ne Atlanta GA 30342-1606 Ph: () - | Northside Urgent Care Holding, Llc 1000 Johnson Fy Rd Ne Atlanta GA 30342-1606 Ph: (855) 709-4535 |
| NPI Number | 1679962237 |
|---|---|
| Provider Enumeration Date | 01/20/2015 |
| Last Update Date | 01/11/2023 |
| Medicare PECOS PAC ID | 4587984695 |
|---|---|
| Medicare Enrollment ID | O20150513000795 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679962237 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (Georgia) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | (Georgia) | Primary |
| Provider Name | Brian K Nadolne |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407805872 PECOS PAC ID: 5395736797 Enrollment ID: I20040602001184 |
| Provider Name | Lori B Kuczmanski |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1811096894 PECOS PAC ID: 3779566872 Enrollment ID: I20040610000272 |
| Provider Name | David Asrael |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1386694511 PECOS PAC ID: 3577547058 Enrollment ID: I20040614000845 |
| Provider Name | Macon Core |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1821186057 PECOS PAC ID: 8820060023 Enrollment ID: I20040809000896 |
| Provider Name | Kenneth S Jago |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538133905 PECOS PAC ID: 3375515406 Enrollment ID: I20040810000520 |
| Provider Name | Tessie Thomas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053417949 PECOS PAC ID: 2365490463 Enrollment ID: I20050105000685 |
| Provider Name | Salpi Adrouny |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851304356 PECOS PAC ID: 8729031729 Enrollment ID: I20050302000589 |
| Provider Name | Mark D Winokur |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1508887548 PECOS PAC ID: 5294790234 Enrollment ID: I20050407000096 |
| Provider Name | Bernard F Oddi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245270727 PECOS PAC ID: 6305888264 Enrollment ID: I20050601000720 |
| Provider Name | Laura M Beaty |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205894318 PECOS PAC ID: 3870518384 Enrollment ID: I20051013000041 |
| Provider Name | Andrea H Kovacic |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982740726 PECOS PAC ID: 7113943184 Enrollment ID: I20051101000425 |
| Provider Name | Anne F Lindbloom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578533295 PECOS PAC ID: 9335166073 Enrollment ID: I20051101000458 |
| Provider Name | William P Mcalvany |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1831163955 PECOS PAC ID: 5799686820 Enrollment ID: I20070726000476 |
| Provider Name | Carole F Felser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770682890 PECOS PAC ID: 3274628862 Enrollment ID: I20070927000212 |
| Provider Name | Imtiaz A Khan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1356481261 PECOS PAC ID: 4284717083 Enrollment ID: I20080218000409 |
| Provider Name | Cyrus Irani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700972155 PECOS PAC ID: 6406819036 Enrollment ID: I20080225000039 |
| Provider Name | Steven C Leuallen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1942346838 PECOS PAC ID: 3678643632 Enrollment ID: I20080603000044 |
| Provider Name | Jesse B Cannon |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1497918288 PECOS PAC ID: 3375616873 Enrollment ID: I20080716000555 |
| Provider Name | Crystal A Comeau |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578570644 PECOS PAC ID: 0840365391 Enrollment ID: I20080818000429 |
| Provider Name | Nagalaksmi Suryadevara |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609083344 PECOS PAC ID: 4587739990 Enrollment ID: I20080820000164 |
| Provider Name | Verona Andrea Reid |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548422421 PECOS PAC ID: 8921174202 Enrollment ID: I20080910000568 |
| Provider Name | Kathleen G Funk |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1841264140 PECOS PAC ID: 3678622370 Enrollment ID: I20090529000379 |
| Provider Name | Joseph P Funk |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1063486173 PECOS PAC ID: 6709935315 Enrollment ID: I20090601000009 |
| Provider Name | Vida M Reklaitis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1023093887 PECOS PAC ID: 7719037167 Enrollment ID: I20090608000026 |
| Provider Name | Crystal D Owens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508810227 PECOS PAC ID: 1759432925 Enrollment ID: I20090629000371 |
| Provider Name | Mija Vail |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1588980973 PECOS PAC ID: 5092847442 Enrollment ID: I20100720000750 |
| Provider Name | Sidharth Sharma |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568790848 PECOS PAC ID: 0749477958 Enrollment ID: I20101214000017 |
| Provider Name | Gordon J Peltier |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508805573 PECOS PAC ID: 5496656522 Enrollment ID: I20101216000412 |
| Provider Name | Tian Xia |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1437357423 PECOS PAC ID: 2961681713 Enrollment ID: I20110125001006 |
| Provider Name | Sandra Thomas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376750752 PECOS PAC ID: 0840460705 Enrollment ID: I20110901000113 |
| Provider Name | Tracey C Wallace |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265475206 PECOS PAC ID: 2769383892 Enrollment ID: I20111026000845 |
| Provider Name | Tanya H Eller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851652556 PECOS PAC ID: 5698927515 Enrollment ID: I20121128000516 |
| Provider Name | Kanyan Xiao |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871721068 PECOS PAC ID: 7315183738 Enrollment ID: I20130409000405 |
| Provider Name | Amber D Oglesby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750771853 PECOS PAC ID: 1052639184 Enrollment ID: I20150421001266 |
| Provider Name | Essi I Peers |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1013263250 PECOS PAC ID: 8729396940 Enrollment ID: I20151007001598 |
| Provider Name | Nihinlolawa Oreoluwa Ijamakinwa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174843833 PECOS PAC ID: 8426284571 Enrollment ID: I20151012001271 |
| Provider Name | Kelli M Hardin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851784656 PECOS PAC ID: 0648589622 Enrollment ID: I20151013001710 |
| Provider Name | Daryl Rampersad |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871938969 PECOS PAC ID: 7113237801 Enrollment ID: I20151109002164 |
| Provider Name | Esther Barnes Klein |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225484165 PECOS PAC ID: 8123313608 Enrollment ID: I20160823001446 |
| Provider Name | Jacqueline Ann Nguyen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356633853 PECOS PAC ID: 2769629559 Enrollment ID: I20160830002675 |
| Provider Name | Jennifer Covode |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629423637 PECOS PAC ID: 7113213950 Enrollment ID: I20160906000274 |
| Provider Name | Daniel J. Musser |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679912877 PECOS PAC ID: 8729212287 Enrollment ID: I20161101001402 |
| Provider Name | Abdullah Khalifah Almehbash |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1700226545 PECOS PAC ID: 4789982778 Enrollment ID: I20170203001505 |
| Provider Name | Kanitha Sar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417402108 PECOS PAC ID: 8729361688 Enrollment ID: I20170220001923 |
| Provider Name | Johan Koo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114280419 PECOS PAC ID: 4880906080 Enrollment ID: I20170405001589 |
| Provider Name | Suhas Samuel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356632962 PECOS PAC ID: 9436397163 Enrollment ID: I20170412001973 |
| Provider Name | Pei Tan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851827893 PECOS PAC ID: 6800164963 Enrollment ID: I20170613001671 |
| Provider Name | Mary Kathleen Hesidence |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336706316 PECOS PAC ID: 3971830688 Enrollment ID: I20190802002068 |
| Provider Name | Darren Dillard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497100697 PECOS PAC ID: 6103110481 Enrollment ID: I20190919000023 |
| Provider Name | Kacie J Graves |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871143396 PECOS PAC ID: 0547592339 Enrollment ID: I20191028002907 |
| Provider Name | Allison Heather Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538701263 PECOS PAC ID: 2264865906 Enrollment ID: I20191210002460 |
| Provider Name | Brittany Elisa Machado |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326690561 PECOS PAC ID: 1759715816 Enrollment ID: I20191223002000 |
| Provider Name | Melanie Tubb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427691047 PECOS PAC ID: 5799110987 Enrollment ID: I20200116000758 |
| Provider Name | Abiola Saibu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831543081 PECOS PAC ID: 8628361938 Enrollment ID: I20200217000255 |
| Provider Name | James Richardson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1790765584 PECOS PAC ID: 0345149340 Enrollment ID: I20210330000982 |
| Provider Name | Krunal Jethwa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457607400 PECOS PAC ID: 7719117860 Enrollment ID: I20210503000371 |
| Provider Name | Michael Alan Applegate |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891379608 PECOS PAC ID: 1658772454 Enrollment ID: I20210630003739 |
| Provider Name | Maryann Forbes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689347668 PECOS PAC ID: 9638569890 Enrollment ID: I20211201002345 |
| Provider Name | Jorge Margiela |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467984138 PECOS PAC ID: 4981976420 Enrollment ID: I20211230000059 |
| Provider Name | Francesca Damus |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598225997 PECOS PAC ID: 8527392331 Enrollment ID: I20230505001065 |
| Provider Name | Nilomee Kaushik Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033981212 PECOS PAC ID: 7315396751 Enrollment ID: I20231212000243 |
| Provider Name | John T Maclachlan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750143699 PECOS PAC ID: 3072951516 Enrollment ID: I20240403002967 |
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