SOUTHSIDE MEDICAL CENTER, INC. (NPI# 1588088025) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588088025 |
| Entity Type | Organization |
| Organization Name | SOUTHSIDE MEDICAL CENTER, INC. |
| Other Organization Name | SOUTHSIDE MEDICAL CENTER - JACKSON CLINIC |
| Practice Address |
176 Lyons St Jackson GA 30233-2134 |
| Mailing 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 | 2014-02-04 |
| Last Update Date | 2015-09-14 |
| Authorized Official Name | DR. DAVID M WILLIAMS (CEO) |
| Authorized Official Telephone | 4046881350 |
| Authorized Official Credential | M.D. |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000444056O | 05 |
| Other Name | Type Code |
|---|---|
| Southside Medical Center - Jackson Clinic | Doing Business As 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 |
| 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 |
| 1235123993 | Southside Medical Center, Inc. | Clinic/Center | 1046 Ridge Ave Sw, Atlanta, GA 30315-1640 | 2005-09-08 |
| 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 |
176 LYONS ST |
| City | JACKSON |
| State | GA |
| Zip Code | 30233-2134 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366800914 | Georgia Ophthalmologists LLC | Durable Medical Equipment & Medical Supplies | 860 W 3rd St, Jackson, GA 30233 | 2016-02-10 |
| 1306225057 | Young Dreaden | Nurse Practitioner | 2978 Hwy 36w, Jackson, GA 30233 | 2015-05-28 |
| 1609255520 | Neta J Roby | Nurse Practitioner | Hwy 36, Georgia Diagnostic Classification Prison, Jackson, GA 30233 | 2015-05-26 |
| 1033546098 | Henrietta Lindsay | Social Worker | 463-b Ernest Biles Dr, Jackson, GA 30233 | 2013-10-04 |
| 1255776993 | Gareth Gene Walker | Technician | 514 Covinton Street, Jackson, GA 30233 | 2013-05-08 |
| 1730489592 | Mary L. Melton | Licensed Practical Nurse | 463 Ernest Biles Dr., Jackson, GA 30233 | 2010-10-27 |
| 1083864250 | Chastity Moore Brown | Dentist | 1520 Lucky Street, Griffin, GA 30233 | 2008-09-24 |
| 1568661320 | Joseph Fowlkes | Internal Medicine | 2978 Highway 36 W, Jackson, GA 30233 | 2007-07-12 |
| 1942386289 | Butts County Board of Commissioners | Ambulance | 154 Sylvan Drive, Jackson, GA 30233 | 2006-10-30 |
| 1841238300 | Jackson Pharmacy Services | Pharmacy | 22 Mulberry St., Jackson, GA 30233 | 2006-06-04 |
| Find all providers in zip 30233 | ||||
| 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 |
|---|---|---|---|---|
| 1689047292 | Central Mississippi Civic Improvement Association, Inc | Clinic/Center | 3930 Skyview Dr, Jackson, MS 39213-5318 | 2015-11-04 |
| 1134592777 | Central Mississippi Civic Improvement Association, Inc | Clinic/Center | 415 Claiborne Ave, Jackson, MS 39209-5321 | 2015-11-04 |
| 1326328311 | Rural Health Services, Inc. | Clinic/Center | 210 Atomic Rd, Jackson, SC 29831-3409 | 2011-08-22 |
| 1427377266 | Central Mississippi Civic Improvement Association, Inc. | Clinic/Center | 350 Woodrow Wilson Blvd, Jackson, MS 39213-4454 | 2010-05-19 |
| 1376732313 | Central Mississippi Civic Improvement Association | Clinic/Center | 1716 Isable St, Jackson, MS 39204-2352 | 2007-10-16 |
| 1447448667 | Central Mississippi Civic Improvement Association | Clinic/Center | 2185 Fortune St, Jackson, MS 39204-2333 | 2007-10-12 |
| 1205021946 | Central Mississippi Civic Improvement Association, Inc | Clinic/Center | 327 S Gallatin St, Jackson, MS 39203-3514 | 2007-09-06 |
| 1598893547 | Rural Health Group, Inc. | Clinic/Center | 9409 Nc Hwy 305, Jackson, NC 27845-0594 | 2007-03-01 |
| 1023100955 | Community Action Committee of Pike County | Clinic/Center | 14590 State Route 93, Jackson, OH 45640-8977 | 2006-09-28 |
| 1255360483 | Central Mississippi Civic Improvement Association, Inc. | Clinic/Center | 1655 Whiting Rd, Jackson, MS 39209-5826 | 2006-07-01 |
| Find all providers in JACKSON | ||||
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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.