NPIMap

Organization Active NPI

Laureate Medical Group at Northside LLC

  • Internal Medicine Physician
  • Atlanta, GA
National Provider Identifier
1811037336
Registry record updated Aug 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 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
Last updated
Aug 12, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 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
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

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 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
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

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
11D0258955Laureate Medical Group at Northside, LLC1110 West Peachtree Street, NW, Suite 1100, Atlanta, GA 30309Certificate of waiverAug 16, 2026

National Provider Directory

National Provider Directory

Member of 1

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

Locations

3400 Old Milton Pkwy
Ste 500
Alpharetta, GA 30005
Phone (678) 775-2284

1110 W Peachtree St NW
Ste 1100
Atlanta, GA 30309
Phone (404) 256-8500

470 Northside Cherokee Blvd
Ste 490
Canton, GA 30115
Phone (678) 538-2167

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

1121 Johnson Ferry Rd
Bldg 1
Marietta, GA 30068
Phone (678) 718-2940

6135 Barfield Rd
Sandy Springs, GA 30328
Phone (404) 250-6691

6600 Peachtree Dunwoody Rd
Bldg 600
Sandy Springs, GA 30328

980 Johnson Fy Rd NE
Ste 490
Sandy Springs, GA 30342
Phone (404) 257-0133

Practitioners & affiliated clinicians

Practitioners 85

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 85

NPI Registry JSON

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786492800000",
    "number": "1811037336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 W PEACHTREE ST NW STE 1100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303093609",
            "telephone_number": "404-892-2131",
            "fax_number": "404-215-9222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 W PEACHTREE ST NW STE 1100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303093609",
            "telephone_number": "404-892-2131",
            "fax_number": "404-215-9222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAUREATE MEDICAL GROUP AT NORTHSIDE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2026-08-12",
        "certification_date": "2026-08-12",
        "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": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "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",
            "address_2": "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 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.