Northside Hospital, Inc.
Organization Active NPI General Acute Care Hospital · Canton, GA
NPI 1225050396 · NPPES record last updated Jun 12, 2026
Key facts
- NPI
- 1225050396
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 028552 (GA)
- Legal business name
- NORTHSIDE HOSPITAL, INC.
- Practice address
- 450 Northside Cherokee Blvd
Canton, GA 30115-8015 - Phone
- (770) 224-1000
- NPI assigned
- Jul 24, 2006
- Organization subpart
- No
Authorized official
- Name
- Amy E Fouts
- Title
- Chief Compliance Officer
- Phone
- (404) 851-6968
Owners & managing parties with NPI records 18
-
Wayne L Ambroze, MD
-
Dale Mitchell Bearman, M.D.
-
Alan K Carnes, MD
-
Genevieve L Fairbrother, M.D.
-
Iqbal S. Garcha, M.D.
-
Josef F Venable, M.D.
Owned or controlled facilities with NPI records 2
Other NPIs on the same Medicare enrollment 5
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 4
Member of 1
Facilities with the same owner 2
Practitioners 72
-
Chris M Carter, PA
-
Demetria Lynne Aaron, M.D.
-
Birmaji Ali, MD
-
Mosaab Awad, MD
-
Robert Ross Barrett, MD, FACOG
-
Douglas M Cardillo, M.D.
-
Arinze Hector Duru, M.D
-
Laura L Gibbs, M.D.
-
Venkata Sai Gogineni, M.D.
-
Salam O Hadrami, MD
-
Paul J Hyler, M.D.
-
Joon Dong Kim, M.D.
-
Dominik Kissing, M.D.
-
Kailash Pradip Kulkarni, M.D.
-
Najia C Lawrence, MD
-
Spencer Michael Lee, M.D.
Affiliated clinicians 1,228
-
Ashley M Abbott, MD
-
Eddie K. Abdalla, M.D.
-
Adriana Acosta-Prows, ARNP
-
Samuel F Adams, M.D.
-
Erica Addison, AA-C
-
Santhi Adigopula, MD
-
Ashley Agbulos, C-AA
-
Lauren Galbraith Agee, NP-C
-
Ignazio Agrippina, D.C.
-
Kelly J. Ahn, M.D.
-
Ayushi Ahuja, M.D.
-
Maho Akamatsu, MD
-
Saresh Akmal, MD
-
Hatem Al Kassem, M.D.
Medicare Care Compare: Hospital
- Listed as
- Northside Hospital Cherokee
- Overall star rating
- ★★★★☆ 4 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Other
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
Hospital certification: CCN 110008
- Legal name
- NORTHSIDE HOSPITAL INC
- Doing business as
- NORTHSIDE HOSPITAL CHEROKEE
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Oct 11, 2024
- Beds
- 84
- Ownership / control type
- Other
- Most recent change of ownership
- Jan 1, 2010 (2 total)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 25, 1991 in GA
- Enrollment address
- 450 Northside Cherokee Blvd
Canton, GA 30115-8015 - Hospital subgroups
- General
All disclosed owners & managing parties 21
| Name | Role | Since | Share |
|---|---|---|---|
| Keith Buchanan |
Corporate Director |
Aug 28, 2019 | |
| Jorge J Hernandez |
Corporate Officer |
Jan 1, 2018 | |
| W-2 Managing Employee |
Dec 7, 2009 | ||
| Robert T. Quattrocchi |
Corporate Officer |
Oct 8, 2004 | |
| Corporate Director |
May 1, 2004 | ||
| Thurbert Baker |
Corporate Director |
May 6, 2019 | |
| Wayne Sikes |
Corporate Director |
Aug 28, 2019 | |
| Terri Jondahl |
Corporate Director |
Aug 28, 2019 | |
| Alan K Carnes |
Corporate Director |
Aug 28, 2019 | |
| John Levengood |
Corporate Director |
Aug 28, 2019 | |
| Shannon Banna |
Corporate Officer |
Jan 1, 2018 | |
| W-2 Managing Employee |
Jan 1, 2018 | ||
| William Hayes |
W-2 Managing Employee |
Dec 7, 2009 | |
| Anthony Salvatore |
Corporate Director |
May 1, 2005 | |
| Iqbal Garcha |
Corporate Director |
May 1, 2016 | |
| Amy E Fouts |
Corporate Officer |
Apr 1, 2026 | |
| W-2 Managing Employee |
Apr 1, 2026 | ||
| Nicholas P Gubbins |
Corporate Officer |
Apr 1, 2026 | |
| W-2 Managing Employee | Apr 1, 2026 | ||
| Genevieve L Fairbrother |
Corporate Director |
Feb 2, 2013 | |
| Wayne Lee Ambroze |
Corporate Director |
May 1, 2016 | |
| Josef G Venable |
Corporate Director |
May 1, 2021 | |
| Barbara a Pare |
Corporate Director |
May 8, 2008 | |
| Mark J Sweeney |
Corporate Director |
May 1, 2006 | |
| Northside Hospital Inc |
5% Or Greater Direct Ownership Interest | Jul 25, 1991 | 100% |
| Dale M Bearman |
Corporate Director |
Feb 1, 2007 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Northside Hospital Forsyth |
Hospital | 5% Or Greater Direct Ownership Interest | Jul 25, 1991 |
| Northside Hospital Gwinnett |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Aug 28, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101025001193 | GA | Part a Provider - Hospital | 9830007236 | Practice locations: Woodstock, GA; Jasper, GA; Holly Springs, GA; Canton, GA |
| O20210505001504 | GA | Part B Supplier - Clinic/Group Practice | 4880003771 |
Receives reassigned benefits from 55 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Decatur, GA; Lawrenceville, GA; Johns Creek, GA; Loganville, GA; Macon, GA; Peachtree Corners, GA; Snellville, GA; Suwanee, GA… |
National Provider Directory
- Tax ID family
- Bluemark LLC Office Ally
Locations
450 Northside Cherokee Blvd
Ste 145
Canton, GA 30115
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 028552 | GA | Yes |
Addresses
Primary practice location
450 Northside Cherokee Blvd
Canton, GA 30115-8015
Mailing address
1000 Johnson Fy Rd NE
Sandy Springs, GA 30342-1606
Phone (404) 851-1000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000001108A | Medicaid | GA |
Other names
- Northside Hospital Cherokee
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Bluemark LLC / Office Ally |
Other providers in Canton, GA
- Northside Hospital
- Northside Hospital Cherokee
- Northside Hospital Cherokee
- Northside Hospital Cherokee Inc.
- Northside Hospital, Inc
- Northside Hospital, Inc.
- Northside Medical Specialists
- Northside Spinal Center Inc
- Northside Womens Group LLC
- Northwest Endodontic Specialists, P.C.
All providers in Canton, GA · General Acute Care Hospital in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.