Northside Hospital, Inc.
Organization Active NPI Community/Retail Pharmacy · Lawrenceville, GA
NPI 1619558657 · NPPES record last updated Jun 12, 2026
Key facts
- NPI
- 1619558657
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- NORTHSIDE HOSPITAL, INC.
- Practice address
- 631 Professional Dr Ste 450
Lawrenceville, GA 30046-3370 - Phone
- (678) 533-1559
- NPI assigned
- Apr 20, 2021
- Organization subpart
- No
Authorized official
- Name
- Amy E Fouts
- Title
- Chief Compliance Officer
- Phone
- (404) 851-6968
Owned or controlled facilities with NPI records 3
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 15
Member of 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D0860621 | Northside Hospital Cancer Institute | Accreditation | Jul 21, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Surburban Oncology Pharmacy |
Epoetin|Oral Anticancer Drugs|Oral Antiemetic Drugs | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Northside Hospital Forsyth |
Hospital | 5% Or Greater Direct Ownership Interest | Jul 25, 1991 |
| 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 |
|---|---|---|---|---|
| O20210715003880 | GA | DME Supplier - Pharmacy | 9830007236 | Practice locations: Lawrenceville, GA |
National Provider Directory
- Tax ID family
- Northside Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
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
- Suburban Oncology Pharmacy
Other providers in Lawrenceville, GA
- Northeast Infectious Diseases Inc
- Northside CV Professional Services LLC
- Northside Hospital Inc
- Northside Hospital, Inc.
- Northside Hospital, Inc.
- Northside Hospital, Inc.
- Northside WGG LLC
- Northside Womens Group LLC
- Northwest Diagnostic Imaging, Inc
- J. Alfred Norton
All providers in Lawrenceville, GA · Community/Retail Pharmacy 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.