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NORTHSIDE GWINNETT EXTENDED CARE CENTER PHARMACY
NPI 1437134970
Pharmacy - Long Term Care Pharmacy in Lawrenceville, GA

Active since December 07, 2005CLIA Certified · 9 labs
650 PROFESSIONAL DR, LAWRENCEVILLE, GA 30046(678) 442-3642(770) 442-3066 Get Directions Write a Review

NPPES record last updated: November 10, 2020. Verified against the NPPES registry weekly; last sync: September 20, 2026.

Record update history: Nov 10, 2020, Jun 2, 2020 (2 updates tracked since 2020).

About Northside Gwinnett Extended Care Center Pharmacy NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NORTHSIDE GWINNETT EXTENDED CARE CENTER PHARMACY (NPI 1437134970) is a healthcare organization registered as a long term care pharmacy in Lawrenceville, Georgia and active in the NPI registry since December 2005. The organization holds 9 active CLIA laboratory certificates and lists Judy Gardner, Director, Pharmaceutical Services, as its authorized official.

NPPES Registry Identity

NPI1437134970
Entity TypeOrganization
Primary Taxonomy3336L0003X
Legal Business NameNORTHSIDE HOSPITAL, INC.
Location Address650 PROFESSIONAL DRLawrenceville, GA 30046-8707
Mailing Address1000 Johnson Ferry Road, Attn: Judy GardnerAtlanta, GA 30342-1616 · (404) 851-6793 · Fax (404) 851-8610
Phone(678) 442-3642
Fax(770) 442-3066
Organization SubpartNo
Authorized OfficialJudy GardnerDirector, Pharmaceutical Services · (404) 851-6793
Enumeration DateDecember 7, 2005
Last NPPES UpdateNovember 10, 20202 updates tracked since enumeration
NPPES CertifiedNovember 10, 2020
✔ NPI 1437134970 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacy · Long Term Care PharmacySuppliers
Taxonomy Code3336L0003X
Definition
A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.
Also ListedGeneral Acute Care HospitalTaxonomy 282N00000X · License PHRE008388 (GA)
650 PROFESSIONAL DR, Lawrenceville, GA 30046
Open in Google Maps ↗

Other Names 1

Doing Business AsNorthside Gwinnett Extended Care Center Pharmacy

Other Identifiers 2

Other1147215GA · Nabp Or Ncpdp
Medicaid866291AGA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Medica, Moda Health Plan, Inc..Insurance ›

CLIA Laboratory Certificates CMS CLIA 9

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2273786

Northside Hospital Gwinnett Inpatient Annex · Lawrenceville, GA
Active · expires Dec 19, 2026
CLIA Number11D2273786
Laboratory TypeHospital
Certificate Effective DateDecember 20, 2024
Certificate Expiration DateDecember 19, 2026
Laboratory DirectorYekaternia Eichel
Laboratory Phone(678) 312-4520
Laboratory LocationNorthside Hospital Gwinnett Inpatient Annex650 Professional Drive, Lawrenceville, GA 30046
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 11D0920391

Northside Hospital Diagnostic Clinic-Lawrenceville · Lawrenceville, GA
Active · expires Sep 30, 2028
CLIA Number11D0920391
Laboratory TypePhysician Office
Certificate Effective DateOctober 1, 2026
Certificate Expiration DateSeptember 30, 2028
Laboratory DirectorGregory L. Mauldin
Laboratory Phone(770) 297-4907
Laboratory LocationNorthside Hospital Diagnostic Clinic-Lawrenceville500 Medical Center Blvd Ste 160, Lawrenceville, GA 30046
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 11D2287060

Northside Hospital Radiation Oncology - Duluth Hwy · Lawrenceville, GA
Active · expires Aug 7, 2027
CLIA Number11D2287060
Laboratory TypeO/P Dept Of Hospital
Certificate Effective DateAugust 8, 2025
Certificate Expiration DateAugust 7, 2027
Laboratory DirectorDavid Yoo
Laboratory Phone(770) 962-8888
Laboratory LocationNorthside Hospital Radiation Oncology - Duluth Hwy698 Duluth Hwy, Lawrenceville, GA 30046
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 11D2286871

Northside Hospital Radiation Oncology-Philip Blvd · Lawrenceville, GA
Active · expires Aug 3, 2027
CLIA Number11D2286871
Laboratory TypeOutpatient Dept Of Hosp
Certificate Effective DateAugust 4, 2025
Certificate Expiration DateAugust 3, 2027
Laboratory DirectorPhilip Shrake
Laboratory Phone(770) 995-3000
Laboratory LocationNorthside Hospital Radiation Oncology-Philip Blvd311 Philip Boulevard, Lawrenceville, GA 30046
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Accreditation 11D0860621

Northside Hospital Cancer Institute Shoa Lawrenceville · Lawrenceville, GA
Active · expires Jul 21, 2027
CLIA Number11D0860621
Laboratory TypePhysician Office
Certificate Effective DateJuly 22, 2025
Certificate Expiration DateJuly 21, 2027
Laboratory DirectorDr. Amy Starr
Laboratory Phone(770) 963-8030
Laboratory LocationNorthside Hospital Cancer Institute Shoa Lawrenceville631 Professional Drive, Suite 450, Lawrenceville, GA 30046
CLIA data matches this NPI record on: Name
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Certificate of Waiver 11D2229170

Northside Hospital Gwinnett Infusion Center · Lawrenceville, GA
Active · expires Jul 7, 2027
CLIA Number11D2229170
Laboratory TypeOutpatient Dept Of Hosp
Certificate Effective DateJuly 8, 2025
Certificate Expiration DateJuly 7, 2027
Laboratory DirectorPaayal Mehta
Laboratory Phone(678) 312-4220
Laboratory LocationNorthside Hospital Gwinnett Infusion Center575 Professional Drive Suite 510, Lawrenceville, GA 30046
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NORTHSIDE HOSPITAL, INC.
Skilled Nursing Facility
650 PROFESSIONAL DR
LAWRENCEVILLE, GA 30046
Gwinnett County (678) 312-3000
PAULINE CARMELA BONDOC-ROAQUIN P.T.
Physical Therapist
650 PROFESSIONAL DR
LAWRENCEVILLE, GA 30046
Gwinnett County (678) 312-3000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Northside Hospital, Inc.'s NPI number?

The NPI number for Northside Hospital, Inc. is 1437134970. It was assigned to this organization in the NPPES registry on December 7, 2005. The provider is doing business as Northside Gwinnett Extended Care Center Pharmacy.

Where is Northside Hospital, Inc. located?

Northside Hospital, Inc. is located at 650 Professional Dr, Lawrenceville, GA 30046. The listed phone number is (678) 442-3642.

What is Northside Hospital, Inc.'s specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Long Term Care Pharmacy, with taxonomy code 3336L0003X.

Does Northside Hospital, Inc. hold CLIA laboratory certificates?

Yes. 9 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Northside Hospital, Inc. accept?

Health plans from Medica and Moda Health Plan, Inc. list Northside Hospital, Inc. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Northside Hospital, Inc. was last updated on November 10, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.