Provider Demographics
NPI:1700914223
Name:NORTHSIDE FAMILY MEDICINE, LLC
Entity type:Organization
Organization Name:NORTHSIDE FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROON
Authorized Official - Middle Name:
Authorized Official - Last Name:RASHID
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:770-781-9824
Mailing Address - Street 1:580 ATLANTA RD
Mailing Address - Street 2:SUITE 230-A
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2744
Mailing Address - Country:US
Mailing Address - Phone:770-781-9824
Mailing Address - Fax:770-781-9833
Practice Address - Street 1:580 ATLANTA RD
Practice Address - Street 2:SUITE 230-A
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2744
Practice Address - Country:US
Practice Address - Phone:770-781-9824
Practice Address - Fax:770-781-9833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049201261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care