NPIMap

Organization Active NPI

Northside Hospital, Inc.

Doing business as Suburban Oncology Pharmacy

  • Community/Retail Pharmacy
  • Lawrenceville, GA
National Provider Identifier
1619558657
Registry record updated Jun 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
NORTHSIDE HOSPITAL, INC.
Doing business as
Suburban Oncology Pharmacy
Practice address
631 Professional Dr Ste 450
Lawrenceville, GA 30046-3370
Phone
(678) 533-1559
NPI assigned
Apr 20, 2021
Last updated
Jun 12, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2026

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

Authorized official

Name
Amy E Fouts
Title
Chief Compliance Officer
Phone
(404) 851-6968

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

631 Professional Dr Ste 450
Lawrenceville, GA 30046-3370

Mailing address

1000 Johnson Ferry Rd
Atlanta, GA 30342-1606
Phone (404) 851-6378

Other names 1

  • Suburban Oncology Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210715003880 GA DME Supplier - Pharmacy 9830007236 Practice locations: Lawrenceville, GA

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0860621Northside Hospital Cancer Institute631 Professional Drive, Suite 450, Lawrenceville, GA 30046AccreditationJul 21, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Surburban Oncology Pharmacy631 Professional Dr, Lawrenceville, GA 30046-3370(770) 963-8030 Epoetin|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Feb 16, 2006

National Provider Directory

National Provider Directory
Tax ID family
Northside Hospital Emer16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Member of 1

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

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Northside Hospital ForsythCumming, GA, CCN 110005 Hospital 5% Or Greater Direct Ownership Interest Jul 25, 1991
Northside Hospital CherokeeCanton, GA, CCN 110008 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 25, 1991
Northside Hospital GwinnettLawrenceville, GA, CCN 110087 Hospital 5% Or Greater Direct Ownership Interest (100%) Aug 28, 2019

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1618876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781222400000",
    "number": "1619558657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FERRY RD",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421606",
            "telephone_number": "404-851-6378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 PROFESSIONAL DR STE 450",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463370",
            "telephone_number": "678-533-1559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-20",
        "last_updated": "2026-06-12",
        "certification_date": "2026-06-12",
        "status": "A",
        "authorized_official_last_name": "FOUTS",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "404-851-6968"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Suburban Oncology Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Suburban Oncology Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.