NPIMap

Organization Active NPI

Northside Urgent Care Holding, LLC

  • Urgent Care Clinic/Center
  • Atlanta, GA
National Provider Identifier
1679962237
Registry record updated Aug 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
NORTHSIDE URGENT CARE HOLDING, LLC
Practice address
1000 Johnson Fy Rd NE
Atlanta, GA 30342-1606
Phone
(855) 709-4535
NPI assigned
Jan 20, 2015
Last updated
Aug 7, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X GA Primary
General Practice Physician 208D00000X GA

Addresses

Primary practice location

1000 Johnson Fy Rd NE
Atlanta, GA 30342-1606

Mailing address

1000 Johnson Fy Rd NE
Atlanta, GA 30342-1606

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150513000795 GA Part B Supplier - Clinic/Group Practice 4587984695 Receives reassigned benefits from 105 practitioners
Practice locations: Holly Springs, GA; Johns Creek, GA; Lawrenceville, GA; Dawsonville, GA; Loganville, GA; Marietta, GA; Roswell, GA; Snellville, GA…

National Provider Directory

National Provider Directory

Member of 1

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

Locations

1110 W Peachtree St NW
Ste 200
Atlanta, GA 30309
Phone (404) 575-2000

610 Peachtree Pkwy
Ste 130
Cumming, GA 30041
Phone (770) 205-2804

81 Northside Dawson Dr
Ste 100
Dawsonville, GA 30534
Phone (706) 216-6000

7386 Friendship Springs Blvd
Ste J
Flowery Branch, GA 30542
Phone (470) 451-0646

684 Sixes Rd
#125A
Holly Springs, GA 30115
Phone (678) 426-5450

684 Sixes Rd
Ste 125
Holly Springs, GA 30115
Phone (678) 426-5450

665 Duluth Hwy
Ste B
Lawrenceville, GA 30046
Phone (470) 451-0650

1121 Johnson Ferry Rd
Ste 100A
Marietta, GA 30068
Phone (770) 509-1025

4800 Olde Towne Pkwy
Ste 150A
Marietta, GA 30068
Phone (770) 509-1025

11685 Alpharetta Hwy
Ste 150
Roswell, GA 30076
Phone (770) 619-3860

11685 Alpharetta Hwy
Ste 150A
Roswell, GA 30076
Phone (770) 555-5555

660 W Crossville Rd
Ste 110
Roswell, GA 30075
Phone (770) 649-0711

2316 Wisteria Dr
Ste 100
Snellville, GA 30078
Phone (470) 450-0644

5910 Suwanee Dam Rd
#100
Sugar Hill, GA 30518
Phone (470) 326-7600

Practitioners & affiliated clinicians

Practitioners 119

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.

View all 119

NPI Registry JSON

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

{
    "created_epoch": "1421712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786060800000",
    "number": "1679962237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FY RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421606"
        },
        {
            "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": "855-709-4535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE URGENT CARE HOLDING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-20",
        "last_updated": "2026-08-07",
        "certification_date": "2026-08-07",
        "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": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "GA",
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": null,
            "primary": false
        }
    ],
    "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 Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.