Northside Sepc Professional Services, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

NORTHSIDE SEPC PROFESSIONAL SERVICES, LLC

Practice address

1000 Johnson Fy Rd NE
Atlanta, GA 30342-1606

Phone

(404) 851-8000

NPI assigned

Apr 27, 2018

Last updated

Jun 3, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jorge J Hernandez

Title

VP Admin. SRVS/Cco

Phone

(404) 851-6378

Specialties & licenses 1

Addresses

Electronic endpoints 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Northside Hospital, Inc.

  dba Diagnostic Clinic Oncology Pharmacy

  • Community/Retail Pharmacy
  • Gainesville, GA
  • NPI 1326679150

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Wayne L Ambroze, MD

  • Colon & Rectal Surgery Physician
  • Atlanta, GA
  • NPI 1972561405
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1524787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748908800000",
    "number": "1265920029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 JOHNSON FY RD NE STE 780",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FY RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421606",
            "telephone_number": "404-851-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE SEPC PROFESSIONAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-27",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "JORGE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VP ADMIN. SRVS/CCO",
        "authorized_official_telephone_number": "404-851-6378"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct",
            "address_2": "Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Northside Podiatry, PC
• Northside Primary Care Professional Services,LLC
• Northside Radiation Oncology PC
• Northside Radiology Associates LLC
• Northside Respiratory Care
• Northside Surgery Center, Inc
• Northside Surgical Professional Services LLC
• Northside Urgent Care Holding, LLC
• Northside Urgent Care Holding, LLC
• Northside Women's Specialist, P.C.

• Internal Medicine Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.