SOUTHSIDE MEDICAL CENTER, INC. (NPI# 1235123993) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235123993 |
| Entity Type | Organization |
| Organization Name | SOUTHSIDE MEDICAL CENTER, INC. |
| Other Organization Name | SOUTHSIDE HEALTHCARE |
| Practice Address |
1046 Ridge Ave Sw Atlanta GA 30315-1640 |
| Practice Telephone | 4046881350 |
| Practice Fax Number | 4046882962 |
| Mailing Telephone | 4046881350 |
| Mailing Fax Number | 4046882962 |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2011-03-07 |
| Authorized Official Name | CLAUDIO AZZARITI (CFO) |
| Authorized Official Telephone | 4045646972 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QC1500X |
Clinic/Center Specialization: Community Health |
Ambulatory Health Care Facilities | ||
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
GA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000444056B | 05 | |
| GA | BCBS | 04092 | 01 |
| Other Name | Type Code |
|---|---|
| Southside Healthcare | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629510466 | Southside Medical Center, Inc. | Clinic/Center | 2025 Jonesboro Rd Se, Atlanta, GA 30315-6726 | 2016-11-10 |
| 1588088025 | Southside Medical Center, Inc. | Clinic/Center | 176 Lyons St, Jackson, GA 30233-2134 | 2014-02-04 |
| 1730207663 | Southside Medical Center, Inc. | Clinic/Center | 4945 Governors Dr, Forest Park, GA 30297-2134 | 2007-03-27 |
| 1831217488 | Southside Medical Center, Inc. | Clinic/Center | 2578 Gresham Rd Se, Atlanta, GA 30316-4138 | 2007-03-26 |
| 1881711414 | Southside Medical Center, Inc. | Clinic/Center | 578 Windy Hill Rd Se, Smyrna, GA 30080-1367 | 2007-03-26 |
| 1427175090 | Southside Medical Center, Inc. | Clinic/Center | 116 Upper Riverdale Rd Sw, Riverdale, GA 30274 | 2007-03-26 |
| 1245252220 | Southside Medical Center, Inc. | Home Health | 1514 Cleveland Ave Ste 205, East Point, GA 30344-6965 | 2006-07-25 |
| 1063627610 | Southside Medical Center, Inc. | Clinic/Center | 1046 Ridge Ave Sw, Atlanta, GA 30315-1640 | 2007-05-14 |
| 1922125574 | Southside Medical Center, Inc. | Clinic/Center | 5127 Jimmy Carter Blvd, Norcross, GA 30093-1619 | 2007-03-26 |
| 1962529529 | Southside Medical Center, Inc. | Clinic/Center | 2201 Talmadge Rd, Hampton, GA 30228-1608 | 2007-03-26 |
| Street Address |
1046 RIDGE AVE SW |
| City | ATLANTA |
| State | GA |
| Zip Code | 30315-1640 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902427669 | Jacqueline Hamilton | Dietitian, Registered | 1046 Ridge Ave Sw, Atlanta, GA 30315-1640 | 2020-05-04 |
| 1588290670 | Rutubula Pettaway | Social Worker | 1046 Ridge Ave Sw, Atlanta, GA 30315-1640 | 2020-03-20 |
| 1063975944 | Donnamarie Wilson | Registered Nurse | 1046 Ridge Ave Sw, Atlanta, GA 30315 | 2019-04-09 |
| 1225598030 | Joi Raines | Nurse Practitioner | 1046 Ridge Ave Sw, Atlanta, GA 30315-1640 | 2019-03-20 |
| 1417432006 | Taylor Breann Gonzalez | Advanced Practice Midwife | 1046 Ridge Ave Sw, Atlanta, GA 30315-1640 | 2018-09-28 |
| 1154810299 | Keli Chapman | Midwife | 1046 Ridge Ave Sw, Atlanta, GA 30315-1640 | 2018-05-03 |
| 1730680992 | Dena Boykin | Dental Hygienist | 1046 Ridge Ave Sw, Atlanta, GA 30315-1640 | 2018-02-23 |
| 1063913234 | Sadaf Rehmani | Dental Hygienist | 1046 Ridge Ave Sw, Atlanta, GA 30315-1640 | 2018-02-23 |
| 1629519251 | Anita Khimani | Clinic/Center | 1046 Ridge Ave Sw, Atlanta, GA 30315-1640 | 2017-03-15 |
| 1750821997 | Faith Jean-louis | Nurse Practitioner | 1046 Ridge Ave Sw, Atlanta, GA 30315-1640 | 2017-03-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083181341 | Erin Cole | Specialist/Technologist | Lakewood Ave Se, Atlanta, GA 30315 | 2018-10-25 |
| 1942701081 | Julie Crocker | Dental Hygienist | 1046 Ridge Ave. Sw, Atlanta, GA 30315 | 2018-02-23 |
| 1457695850 | Dominica Aquino Morales-gibson | Physical Therapist | 2850 Springdale Road Sw, Atlanta, GA 30315 | 2012-11-26 |
| 1912264813 | Maxwell Uhakheme | Internal Medicine | 6875 Douglas Blvd, Suite A, Kaiser Permanente Douglasville Medical Center, Douglasville, GA 30315 | 2012-04-16 |
| 1427329093 | Sulonda Smith | Counselor | 34 Atlanta Ave. Se, Hank Aaron Blvd, Atlanta, GA 30315 | 2012-01-13 |
| 1407152507 | Gerald Leroy Griffin | Pharmacist | 520 Boulevard, Atlanta, GA 30315 | 2011-02-07 |
| 1245404854 | Tunisia Finch Cornelius | Dermatology | 1039 Grant St Se Ste A-11, Atlanta, GA 30315 | 2008-04-15 |
| 1356512180 | Chandra Blakely | Counselor | 215 Lakewood Way, Suite 205, Atlanta, GA 30315 | 2008-03-19 |
| 1104043967 | Alvin H. Clair, M.d.p.c. | Dermatology | 777 Cleveland Ave.,sw Ste.500, Atlanta, GA 30315 | 2007-04-20 |
| 1396877742 | Scott M Russell | Speech-Language Pathologist | 1364 Clifton Road, Atlanta, GA 30315 | 2007-03-12 |
| Find all providers in zip 30315 | ||||
| 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 |
|---|---|---|---|---|
| 1366066243 | Health Education Assessment and Leadership Inc | Clinic/Center | 225 Griffin St Nw, Atlanta, GA 30314-3917 | 2020-06-05 |
| 1285277608 | Saint Joseph's Mercy Care Services, Inc. | Clinic/Center | 1976 Flat Shoals Rd Se Ste B, Atlanta, GA 30316-2857 | 2019-10-18 |
| 1700328309 | Health Education Assessment and Leadership, Inc | Clinic/Center | 4215 Bakers Ferry Rd Sw, Miles Elementary School, Atlanta, GA 30331-4401 | 2016-11-14 |
| 1629510466 | Southside Medical Center, Inc. | Clinic/Center | 2025 Jonesboro Rd Se, Atlanta, GA 30315-6726 | 2016-11-10 |
| 1639527237 | Saint Joseph's Mercy Care Services, Inc. | Clinic/Center | 160 Pine Street Ne, Atlanta, GA 30308-2324 | 2016-05-25 |
| 1912365263 | Fulton County Government | Clinic/Center | 265 Boulevard Ne Fl 3, Atlanta, GA 30312-1208 | 2016-02-02 |
| 1154728335 | Saint Joseph's Mercy Care Services, Inc. | Clinic/Center | 2836 Springdale Rd Sw, Atlanta, GA 30315-7802 | 2014-12-03 |
| 1689090896 | Saint Joseph's Mercy Care Services, Inc. | Clinic/Center | 355 Peachtree St Ne, Atlanta, GA 30308-3256 | 2014-03-12 |
| 1760741102 | The Family Health Centers of Georgia, Inc | Clinic/Center | 3700 Martin Luther King Jr Dr Sw, Atlanta, GA 30331-3674 | 2012-05-04 |
| 1881960722 | Thunder Bay Community Health Service, Inc | Clinic/Center | 10500 County Road 489, Atlanta, MI 49709 | 2012-03-26 |
| Find all providers in ATLANTA | ||||
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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.