SOUTHSIDE MEDICAL CENTER, INC. (NPI# 1831217488) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831217488 |
| Entity Type | Organization |
| Organization Name | SOUTHSIDE MEDICAL CENTER, INC. |
| Other Organization Name | SOUTHSIDE HEALTHCARE |
| Practice Address |
2578 Gresham Rd Se Atlanta GA 30316-4138 |
| Mailing Address |
1046 Ridge Ave Sw Atlanta GA 30315-1640 |
| Practice Telephone | 4042412336 |
| Mailing Telephone | 4046881350 |
| Mailing Fax Number | 4046882962 |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2008-06-12 |
| Authorized Official Name | CLAUDIO AZZARITI (CFO) |
| Authorized Official Telephone | 4045647009 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261Q00000X | Clinic/Center | 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 | 000444056C | 05 |
| 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 |
| 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 |
2578 GRESHAM RD SE |
| City | ATLANTA |
| State | GA |
| Zip Code | 30316-4138 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952568263 | Dexter L Summerlin | Dentist | 2578 Gresham Rd Se, Atlanta, GA 30316-4138 | 2008-05-22 |
| 1548388101 | Southside Medical Center, Inc. | Clinic/Center | 2578 Gresham Rd Se, Atlanta, GA 30316-4138 | 2007-03-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073156923 | Rakiya Williams | Counselor | 1030 Fayetteville Rd., Atlanta, GA 30316 | 2019-10-23 |
| 1215585815 | Madison Victoria Baugh | Counselor | Chris180, 1030 Fayetteville Rd, Atlanta, GA 30316 | 2019-08-28 |
| 1265089460 | Josee Dominque Muldrew | Counselor | 1030 Fayetteville Rd. Se, Atlanta, GA 30316 | 2019-08-22 |
| 1255984241 | Monique Overstreet | Counselor | 1030 Fayetteville Road, Atlanta, GA 30316 | 2019-07-19 |
| 1023573979 | Publix Super Markets, Inc. | Durable Medical Equipment & Medical Supplies | 905 Memorial Drive Se, Atlanta-fulton, GA 30316 | 2019-02-05 |
| 1740726454 | Jimmy Brian Sambula | Behavior Technician | 1017 Fayetteville Rd. Se, Atlanta, GA 30316 | 2017-01-19 |
| 1033665039 | Liberty Group Senior Services | Clinic/Center | 1879 Glenwood Avenue, Atlanta, GA 30316 | 2016-08-30 |
| 1043673650 | The Kroger Co | Durable Medical Equipment & Medical Supplies | 800 Glenwood Ave Se, Atlanta, GA 30316 | 2016-03-31 |
| 1992143382 | Ayodele Osasona | Surgery | 2004 Oak Terrace Dr Se, Atlanta, GA 30316 | 2013-06-07 |
| 1891945721 | Denise Renee Cagle | Social Worker | 1471 Town Country Dr Se, Atlanta, GA 30316 | 2008-09-28 |
| Find all providers in zip 30316 | ||||
| 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 | ||||
Please comment or provide details below to improve the information on SOUTHSIDE MEDICAL CENTER, INC..
| 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.