Northside Hospital, Inc.
Organization Active NPI General Acute Care Hospital · Duluth, GA
NPI 1790715381 · NPPES record last updated Jun 12, 2026
Key facts
- NPI
- 1790715381
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 067-628 (GA)
- Legal business name
- NORTHSIDE HOSPITAL, INC.
- Practice address
- 3620 Howell Ferry Rd
Duluth, GA 30096-3178 - Phone
- (678) 312-6800
- NPI assigned
- Jul 3, 2006
- Organization subpart
- No
Authorized official
- Name
- Amy E Fouts
- Title
- Chief Compliance Officer
- Phone
- (404) 851-6968
Owners & managing parties with NPI records 7
-
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 3
Other NPIs on the same Medicare enrollment 6
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 4
Member organizations 3
Related certifications (CCN) 1
Practitioners 127
-
Madhurima Adulla, M.D
-
Jill M Antisell, CNM
-
Margaret Apara, APRN
-
Purnima Bansal, M.D.
-
Mary E. Bergh, MD
-
Karla L Booker, MD
-
I-Wen Chang, M.D.
-
Mark D. Darrow, M.D.
-
Andrew Garrett Dickerson, M.D.
-
Nam Ky DO, MD
-
Mark G. Ferrara, M.D.
-
Allan Freedman, M.D.
-
Neal Frenkel, MD
-
Daniel Joseph Frilingos, M.D.
-
Gedion A Getachew, M.D.
Affiliated clinicians 691
-
Deborah Adebisi, NP
-
Olaitan Adeniji, MD
-
Kelly Marie Adkins, M.D.
-
Madhurima Adulla, M.D
-
Zaheer Ahammad, DPM
-
Olayinka Akinpelu, MD; MPH
-
Omoleye Akinsola, MD
-
Hatem Al Kassem, M.D.
-
Riyadh Al-Rubaye, MD
-
Aakash Amin, M.D.
-
Christie Wells Anderegg, PA - C
-
Ronald E Anglade, M.D.
-
Betty L. Anthony, M.D.
-
Mariam Anwar, MD
Medicare Care Compare: Hospital
- Listed as
- Northside Hospital Duluth
- Overall star rating
- ★★★★☆ 4 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare Care Compare: Inpatient rehabilitation facility
- Listed as
- Northside Hospital Duluth
- Ownership
- Non-profit
- Certified
- Jul 1, 2021
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D0256605 | Northside Hospital Duluth | Accreditation | Feb 8, 2027 |
| 11D0901200 | Northside Hospital Duluth | Accreditation | Jan 17, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in GA
Hospital certification: CCN 110252
- Legal name
- NORTHSIDE HOSPITAL INC
- Doing business as
- NORTHSIDE HOSPITAL DULUTH
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 2021
- Last certification
- Oct 25, 2024
- Beds
- 122
- Ownership / control type
- Private (not for profit)
- Organization structure
- Other · Non-profit
- Incorporated
- Sep 25, 1991 in GA
- Enrollment address
- 3620 Howell Ferry Rd
Duluth, GA 30096-3178 - Hospital subgroups
- General, Acute care, Rehabilitation unit
Hospital certification: CCN 11T252
- Legal name
- NORTHSIDE HOSPITAL INC
- Organization structure
- Other · Non-profit
- Enrollment address
- 3215 McClure Bridge Rd
Duluth, GA 30096-3223 - Hospital subgroups
- Rehabilitation unit
All disclosed owners & managing parties 20
| Name | Role | Since | Share |
|---|---|---|---|
| Keith Buchanan |
Corporate Director |
Aug 28, 2019 | |
| Corporate Director |
Aug 8, 2019 | ||
| Robert T. Quattrocchi |
Corporate Officer |
Oct 28, 2004 | |
| Corporate Director |
Oct 28, 2004 | ||
| Corporate Director |
Oct 28, 2004 | ||
| Thurbert Baker |
Corporate Director |
May 6, 2019 | |
| Wayne Sikes |
Corporate Director |
Aug 28, 2019 | |
| Alan K Carnes |
Corporate Director |
Aug 28, 2019 | |
| John Levengood |
W-2 Managing Employee | Aug 28, 2019 | |
| Shannon Banna |
Corporate Officer |
Jan 1, 2018 | |
| W-2 Managing Employee |
Jan 1, 2018 | ||
| Anthony Salvatore |
Corporate Director |
May 1, 2005 | |
| Corporate Director |
May 1, 2005 | ||
| Iqbal Garcha |
Corporate Director |
Feb 1, 2016 | |
| Amy E Fouts |
Corporate Officer |
Apr 1, 2026 | |
| W-2 Managing Employee | Apr 1, 2026 | ||
| Nicholas P Gubbins |
Corporate Officer |
Apr 1, 2026 | |
| W-2 Managing Employee | Apr 1, 2026 | ||
| Corporate Officer | Apr 1, 2026 | ||
| Genevieve L Fairbrother |
Corporate Director |
Feb 1, 2016 | |
| Wayne Lee Ambroze |
Corporate Director |
Feb 1, 2016 | |
| Deborah S Mitcham |
Corporate Officer |
Aug 29, 2019 | |
| Corporate Officer | Jul 1, 2021 | ||
| Josef G Venable |
Corporate Director | May 1, 2021 | |
| Barbara a Pare |
Corporate Director |
May 1, 2008 | |
| Corporate Director | May 1, 2008 | ||
| Mark J Sweeney |
Corporate Director |
May 1, 2006 | |
| Dale M Bearman |
Corporate Director |
Feb 1, 2007 | |
| Jorge J Hernandez |
Corporate Officer |
Nov 19, 2007 | |
| W-2 Managing Employee |
Nov 19, 2007 | ||
| Terri Jondahl |
Corporate Director |
Aug 28, 2019 |
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 |
|---|---|---|---|---|
| O20040309000009 | GA | Part B Supplier - Clinic/Group Practice | 8123916426 |
Receives reassigned benefits from 100 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lawrenceville, GA; Duluth, 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… |
| O20210706002144 | GA | Part a Provider - Hospital | 9830007236 | Practice locations: Duluth, GA |
| O20210922003505 | GA | Part a Provider - Hospital | 9830007236 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Duluth, GA |
National Provider Directory
- Tax ID family
- Bluemark LLC Office Ally
Locations
2098 Teron Trce
Dacula, GA 30019
2108 Teron Trce
#100A
Dacula, GA 30019
Phone (678) 312-9120
2078 Teron Trce
Ste 200
Dacula, GA 30019
Phone (678) 312-8600
3855 Pleasant Hill Rd
Ste 330
Duluth, GA 30096
Phone (678) 312-6200
3855 Pleasant Hill Rd
Ste 400
Duluth, GA 30096
Phone (678) 312-7440
1132 Athens Hwy
Ste 208210
Grayson, GA 30017
Phone (678) 312-8340
100 Medical Center Blvd
Ste 210
Lawrenceville, GA 30046
Phone (678) 312-6040
631 Professional Dr
Ste 190
Lawrenceville, GA 30046
Phone (678) 312-8643
1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356
500 Medical Center Blvd
Ste 50
Lawrenceville, GA 30046
500 Medical Center Blvd
Ste 31
Lawrenceville, GA 30046
500 Medical Center Blvd
Ste 310
Lawrenceville, GA 30046
Phone (678) 312-5527
500 Medical Center Blvd
Ste 180
Lawrenceville, GA 30046
Phone (770) 339-0039
631 Professional Dr
Ste 450
Lawrenceville, GA 30046
Phone (770) 963-8030
500 Medical Center Blvd
Ste 130
Lawrenceville, GA 30046
Phone (470) 325-1539
755 Walther Rd
Ste 130
Lawrenceville, GA 30046
Phone (678) 328-1760
361 Delaware Ave
Buffalo, NY 14202
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 067-628 | GA | Yes |
Addresses
Primary practice location
3620 Howell Ferry Rd
Duluth, GA 30096-3178
Mailing address
1000 Johnson Fy Rd NE
Sandy Springs, GA 30342-1606
Phone (404) 851-6378
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1064A | Medicaid | GA |
Other names
- Northside Hospital Duluth
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 Duluth, GA
- North Atlanta Orthopaedic Surgery Center
- North Atlanta Pdoiatry GRP, PC
- North Georgia Oral and Facial Surgery LLC
- North of Atlanta Pain Clinic, LLC
- Northside Hospital, Inc.
- Jean Gerald Nougaisse
- Nova Medical Clinic LLC
- Patrick Nugent
- Nukoa Eyecare LLC
- Nukoa Family Dental
All providers in Duluth, 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.