Northside Hospital, Inc.
Organization Active NPI General Acute Care Hospital · Cumming, GA
NPI 1376574277 · NPPES record last updated Jun 12, 2026
Key facts
- NPI
- 1376574277
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 058604 (GA)
- Legal business name
- NORTHSIDE HOSPITAL, INC.
- Practice address
- 1200 Northside Forsyth Dr
Cumming, GA 30041-7659 - Phone
- (404) 851-8000
- NPI assigned
- Jul 6, 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
Facilities with the same owner 2
Practitioners 71
-
Sean Eugen Delaney, M.D.
-
Allyson Smith, PA
-
Bobby Gene Stout Jr., PA-C
-
Mandy C Stout, PA-C
-
Mariah Wood Thaxton, P.A.
-
Adekemi Oluseun Adedeji, D.O.
-
Madhurima Adulla, M.D
-
Komal Agarwal, MD
-
Seham Al Haddad, M.D.
-
William Boling, M.D.
-
William Childs, D.O.
-
Mary Elizabeth Eaccarino, M.D.
-
Alison Virginia Fountain, M.D.
-
Tolly Garrett, M.D.
-
Deanna Henderson-Martin, M.D.
Affiliated clinicians 1,526
-
Mahboob Aamer, M D
-
John Thomas Abbott Jr., M.D.
-
Eddie K. Abdalla, M.D.
-
Benjamin Abraham, DO
-
Lindsey Michelle Abreu, FNP-C
-
Adekemi Oluseun Adedeji, D.O.
-
Alexis Adeojo, PA-C
-
Santhi Adigopula, MD
-
Madhurima Adulla, M.D
-
Komal Agarwal, MD
-
Ismailu O Agbaje, PHD MD
-
Lauren Galbraith Agee, NP-C
-
Deepak K Aggarwal, M.D.
-
Anbar Ahmad, M.D.
-
Osman Ahmed, MD
-
Kelly J. Ahn, M.D.
Medicare Care Compare: Hospital
- Listed as
- Northside Hospital Forsyth
- Overall star rating
- ★★★★☆ 4 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in GA
Hospital certification: CCN 110005
- Legal name
- NORTHSIDE HOSPITAL INC
- Doing business as
- NORTHSIDE HOSPITAL FORSYTH
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Oct 25, 2024
- Beds
- 389
- Ownership / control type
- Private (not for profit)
- Most recent change of ownership
- Oct 1, 2002 (6 total)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 25, 1991 in GA
- Enrollment address
- 1200 Northside Forsyth Drive
Cumming, GA 30041-7659 - Hospital subgroups
- General, Acute care, Short-term
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 | Nov 19, 2007 | ||
| Robert T. Quattrocchi |
Corporate Officer | Oct 28, 2004 | |
| Corporate Director | Nov 8, 2002 | ||
| W-2 Managing Employee | Nov 8, 2002 | ||
| 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 Hasty |
Corporate Director | Aug 1, 2009 | |
| Anthony Salvatore |
Corporate Director | Nov 19, 2007 | |
| Clyde N Davis |
Corporate Director | Aug 28, 2019 | |
| Iqbal Garcha |
Corporate Director | May 1, 2016 | |
| Genevieve L Fairbrother |
Corporate Director | Feb 2, 2013 | |
| Wayne Lee Ambroze |
Corporate Director | May 1, 2016 | |
| Josef G Venable |
Corporate Director | May 1, 2021 | |
| Lynn a Jackson |
Corporate Officer | Oct 6, 2023 | |
| W-2 Managing Employee |
Oct 6, 2023 | ||
| Barbara a Pare |
Corporate Director | Apr 14, 2009 | |
| Mark J Sweeney |
Corporate Director | Nov 19, 2007 | |
| Northside Hospital Inc |
5% Or Greater Direct Ownership Interest | Jul 25, 1991 | |
| Dale M Bearman |
Corporate Director | Nov 19, 2007 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Northside Hospital Cherokee |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | 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 |
|---|---|---|---|---|
| O20021108000000 | GA | Part a Provider - Hospital | 9830007236 | Practice locations: Buford, GA; Snellville, GA; Johns Creek, GA; Gainesville, GA; Dawsonville, GA; Cumming, GA |
| O20111026000375 | GA | DME Supplier - Hospital | 9830007236 | Practice locations: Cumming, 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
225 E 2nd Ave
Ste 260
Escondido, CA 92025
Phone (760) 480-1808
3142 Vista Way
Ste 206
Oceanside, CA 92056
Phone (760) 721-4000
75 N Bascom Ave
Ste 210
San Jose, CA 95128
Phone (408) 294-9000
1001 Summit Blvd
Ste 1000
Brookhaven, GA 30319
699 Church St NE
Ste 200
Marietta, GA 30060
Phone (770) 424-4488
790 Church St NE
Ste 155
Marietta, GA 30060
1100 Johnson Fy Rd NE
Ste 190
Sandy Springs, GA 30342
Phone (404) 419-9970
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 058604 | GA | Yes |
Addresses
Primary practice location
1200 Northside Forsyth Dr
Cumming, GA 30041-7659
Mailing address
1200 Northside Forsyth Dr
Cumming, GA 30041-7659
Other names
- Northside Hospital Forsyth
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 Cumming, GA
- Northeast Georgia Medical Center
- Northland Hearing Centers Inc
- Northside Family Medicine, LLC
- Northside Hospital
- Northside Hospital
- Northside Nephrology,P.C.
- Northside Pulmonary & Sleep Medicine LLC
- Sonia Gabriela Northway
- Northwest Diagnostic Imaging, Inc
- Northwoods Surgery Center LLC
All providers in Cumming, 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.