Laureate Medical Group at Northside LLC
Organization Active NPI Internal Medicine Physician · Atlanta, GA
NPI 1811037336 · NPPES record last updated Aug 12, 2026
Key facts
- NPI
- 1811037336
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- LAUREATE MEDICAL GROUP AT NORTHSIDE LLC
- Practice address
- 1110 W Peachtree St NW Ste 1100
Atlanta, GA 30309-3609 - Phone
- (404) 892-2131
- Fax
- (404) 215-9222
- NPI assigned
- Feb 7, 2007
- Organization subpart
- No
Authorized official
- Name
- Amy E Fouts
- Title
- Chief Compliance Officer
- Phone
- (404) 851-6968
Member of 1
Practitioners 84
-
Angela Tope Adeleke, FNP-C
-
Syed Faizan Ali, M.D.
-
Murad Assaad, MD
-
Gavin Fleming Brown, M.D.
-
Stacey Collene Cox, N.P.-C
-
Gilberto E Delriovives, MSN, APRN, NP-C
-
Neeja Vivek Desai, M.D.
-
Taylor Michelle Dixon, MS, RDN, LD
-
Suma Dronavalli, M.D.
-
Jonathan David Drori, M.D.
-
Mark G. Friedman, MD
-
Laura Agnew Gandy, M.D.
-
Chandra S. Ghosh, MD
-
Alan J. Gottlieb, MD
-
Mary Elizabeth Hardin, M.D.
-
Blair Hoffman, NP-C
-
Melody Bishara Jones, N.P.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D0258955 | Laureate Medical Group at Northside, LLC | Certificate of waiver | Aug 16, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040629001613 | GA | Part B Supplier - Clinic/Group Practice | 2668458530 |
Receives reassigned benefits from 77 practitioners Practice locations: Atlanta, GA; Marietta, GA; Jonesboro, GA; Holly Springs, GA; Cumming, GA; Canton, GA; Alpharetta, GA |
National Provider Directory
Locations
3400 Old Milton Pkwy
Ste 500
Alpharetta, GA 30005
Phone (678) 775-2284
550 Peachtree St NE
Ste 1550
Atlanta, GA 30308
Phone (404) 892-2131
470 Northside Cherokee Blvd
Ste 490
Canton, GA 30115
Phone (678) 538-2167
450 Northside Cherokee Blvd
Canton, GA 30115
Phone (770) 224-1000
2000 Howard Farm Dr
Ste 400
Cumming, GA 30041
Phone (470) 747-3134
684 Sixes Rd
Ste 265
Holly Springs, GA 30115
Phone (770) 720-2221
5673 Peachtree Dunwoody Rd
Ste 775
Sandy Springs, GA 30342
Phone (404) 256-8500
6600 Peachtree Dunwoody Rd
Bldg 600
Sandy Springs, GA 30328
6135 Barfield Rd
Ste 160
Sandy Springs, GA 30328
6135 Barfield Rd
Sandy Springs, GA 30328
Phone (404) 250-6691
980 Johnson Fy Rd NE
Ste 490
Sandy Springs, GA 30342
Phone (404) 257-0133
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
1110 W Peachtree St NW Ste 1100
Atlanta, GA 30309-3609
Mailing address
1110 W Peachtree St NW Ste 1100
Atlanta, GA 30309-3609
Phone (404) 892-2131
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 Atlanta, GA
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- Rajesh Gobind Laungani
- Jennifer Marie Launse
- Lauren E. Bowersox DDS
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- Luke J Laurich
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All providers in Atlanta, GA · Internal Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 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.
- 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.