SOUTHSIDE MEDICAL CENTER, INC (NPI# 1053789511) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053789511 |
| Entity Type | Organization |
| Organization Name | SOUTHSIDE MEDICAL CENTER, INC |
| Other Organization Name | SOUTHSIDE MEDICAL CENTER - SPALDING COUNTY |
| Practice Address |
409 W Solomon St Griffin GA 30223-2831 |
| Mailing Address |
1046 Ridge Ave Sw Atlanta GA 30315-1640 |
| Practice Telephone | 6786888700 |
| Mailing Telephone | 4046881350 |
| Mailing Fax Number | 4046882962 |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2015-09-14 |
| Authorized Official Name | MR. CLAUDIO AZZARITI (CFO) |
| Authorized Official Telephone | 4046881350 |
| Authorized Official Credential | MBA, CPA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Southside Medical Center - Spalding County | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548750573 | Southside Medical Center, Inc | Clinic/Center | 540 Fayetteville Rd Se, Atlanta, GA 30316-2306 | 2018-05-15 |
| Street Address |
409 W SOLOMON ST |
| City | GRIFFIN |
| State | GA |
| Zip Code | 30223-2831 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922238260 | Frances Marie Landrum | Nurse Practitioner | 409 W Solomon St, Griffin, GA 30223-2831 | 2009-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235783036 | Jennifer Lashawn Stevenson | Registered Nurse | 1071 Highway 16 West, Griffin, GA 30223 | 2019-07-30 |
| 1992357644 | Nikki Petty | Behavior Technician | 185 Grady Street, Griffin, GA 30223 | 2019-07-12 |
| 1568940146 | Brenda Pope | Counselor | 1710 Highway 16 West, Griffin, GA 30223 | 2018-08-05 |
| 1073025151 | Vonita Clowers | Specialist | 1424 N. Expy, Suite 115, Griffin, GA 30223 | 2017-10-30 |
| 1912427592 | Sheena Murphy | Registered Nurse | 109 N. 10th Street, Griffin, GA 30223 | 2017-06-23 |
| 1033639612 | Taralyn Rae Sams | Registered Nurse | 109 North 10th Street, Griffin, GA 30223 | 2017-06-23 |
| 1326594656 | Wendell Robinson | Registered Nurse | 109 N.10th Street, Griffin, GA 30223 | 2016-08-28 |
| 1508235466 | Trenisha Jones Mccall | Counselor | 1815 North Expressway, Griffin, GA 30223 | 2015-09-22 |
| 1104224948 | Dawn Tyus | Counselor | 424 W. Taylor Street, Griffin, GA 30223 | 2014-12-10 |
| 1003173030 | Ingles Markets Inc | Pharmacy | 1735 Zebulon Rd, Griffin, GA 30223 | 2012-04-16 |
| Find all providers in zip 30223 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083183180 | Careconnect Health, Inc | Clinic/Center | 1424 N Expressway Ste 121-123, Griffin, GA 30223-1753 | 2018-11-19 |
| 1699207050 | Careconnect Health, Inc. | Clinic/Center | 822 S Hill St, Griffin, GA 30224-4842 | 2017-04-03 |
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| 1366066243 | Health Education Assessment and Leadership Inc | Clinic/Center | 225 Griffin St Nw, Atlanta, GA 30314-3917 | 2020-06-05 |
| 1851924377 | Valley Healthcare System | Clinic/Center | 1458 Benning Dr, Columbus, GA 31903-2200 | 2020-02-13 |
| 1952941528 | Curtis V. Cooper Primary Health Care, Inc | Clinic/Center | 400 E Broad St, Savannah, GA 31401-5104 | 2020-01-13 |
| 1023658523 | Saint Joseph's Mercy Care Services, Inc. | Clinic/Center | 1407 Cobb Parkway Nw, Marietta, GA 30060-6546 | 2020-01-13 |
| 1467092221 | Careconnect Health, Inc. | Clinic/Center | 130 N Lee St, Forsyth, GA 31029-2122 | 2020-01-09 |
| 1417597238 | The Family Health Centers of Georgia, Inc | Clinic/Center | 19 John Maddox Dr Nw Ste B, Rome, GA 30165-1477 | 2020-01-09 |
| 1649810714 | Careconnect Health, Inc. | Clinic/Center | 254 Wright Avenue, Roberta, GA 31078 | 2020-01-07 |
| 1437798725 | Careconnect Health, Inc. | Clinic/Center | 414 S Frontage Rd Lot 53, Forsyth, GA 31029-3025 | 2020-01-03 |
| 1285277608 | Saint Joseph's Mercy Care Services, Inc. | Clinic/Center | 1976 Flat Shoals Rd Se Ste B, Atlanta, GA 30316-2857 | 2019-10-18 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.