MEDICARE: NORTHSIDE HOSPITAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	060450	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457396079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSIDE HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	1000 JOHNSON FY RD NE
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30342-1606
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 JOHNSON FY RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1606
Country	:	US
Telephone Number	:	404-851-8000
Fax Number	:

Authorized Official
Title or Position	:	CHIEF COMPLIANCE OFFICER
Name	:	AMY E FOUTS
Credential	:
Telephone Number	:	404-851-6968

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	06/12/2026

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