Provider Demographics
NPI:1861123580
Name:MARIETTA NORTHSIDE HOSPITAL SERVICES CORP
Entity type:Organization
Organization Name:MARIETTA NORTHSIDE HOSPITAL SERVICES CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HAMZA
Authorized Official - Middle Name:
Authorized Official - Last Name:TANVEER
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:404-721-2432
Mailing Address - Street 1:4800 OLDE TOWNE PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4378
Mailing Address - Country:US
Mailing Address - Phone:404-721-2432
Mailing Address - Fax:
Practice Address - Street 1:4800 OLDE TOWNE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4378
Practice Address - Country:US
Practice Address - Phone:404-721-2432
Practice Address - Fax:717-307-3540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy