SOUTHSIDE MEDICAL CENTER, INC. (NPI# 1922125574) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922125574 |
| Entity Type | Organization |
| Organization Name | SOUTHSIDE MEDICAL CENTER, INC. |
| Other Organization Name | SOUTHSIDE HEALTHCARE |
| Practice Address |
5127 Jimmy Carter Blvd Norcross GA 30093-1619 |
| Mailing Address |
1046 Ridge Ave Sw Atlanta GA 30315-1640 |
| Practice Telephone | 7703683845 |
| 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 | 000444056F | 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 |
| 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 |
| 1962529529 | Southside Medical Center, Inc. | Clinic/Center | 2201 Talmadge Rd, Hampton, GA 30228-1608 | 2007-03-26 |
| Street Address |
5127 JIMMY CARTER BLVD |
| City | NORCROSS |
| State | GA |
| Zip Code | 30093-1619 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104959485 | Hispanic Medical Management | Clinical Medical Laboratory | 5127 Jimmy Carter Blvd, Norcross, GA 30093-1619 | 2007-03-14 |
| 1205196235 | Deborah Gooden Adams Bowman | Physician Assistant | 5127 Jimmy Carter Blvd, Norcross, GA 30093-1619 | 2012-05-24 |
| 1447470737 | Hispanic Medical Management | Clinical Medical Laboratory | 5127 Jimmy Carter Blvd, Norcross, GA 30093-1619 | 2007-04-27 |
| 1821218116 | Hispanic Medical Management | Clinical Medical Laboratory | 5127 Jimmy Carter Blvd, Norcross, GA 30093-1619 | 2007-04-27 |
| 1730309022 | Hispanic Medical Management | Clinical Medical Laboratory | 5127 Jimmy Carter Blvd, Norcross, GA 30093-1619 | 2007-04-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013517465 | Tequila Olivia Banks | Counselor | 8303 Dunleaf Arc Way Nw, Norcross, GA 30093 | 2020-10-27 |
| 1922643485 | Anthony Ervin | Case Manager/Care Coordinator | 6251 Smithpoint Dr. Bldg B, Peachtree Corners, GA 30093 | 2019-11-08 |
| 1164908885 | Marianne Altares | Speech-Language Pathologist | 1709 Oakbrook Lake Dr, Norcross, GA 30093 | 2018-07-16 |
| 1518480763 | Braces Now 14, LLC | Dentist | 4141 Steve Reynolds Blvd, Suite 2, Norcross, GA 30093 | 2017-07-19 |
| 1457802902 | Audrey Fernandes | Dentist | 4846 Jimmy Carter Blvd, Suite 203, Norcross, GA 30093 | 2016-10-19 |
| 1922456318 | Diana Lleras | Counselor | 6020 Dawson Bld Suite I, Norcross, GA 30093 | 2016-05-26 |
| 1376941500 | Katerine Velez | Counselor | 6020 Dawson Blvd., Siute I, Norcross, GA 30093 | 2014-12-22 |
| 1679979017 | Allison Ballay Donnelly | Speech-Language Pathologist | 1626 Jeurgens Ct., Norcross, GA 30093 | 2014-11-12 |
| 1588913701 | Sunrise Pharmacy | Pharmacy | 1235 Indian Trail Rd, Suite 200a, Norcross, GA 30093 | 2012-09-04 |
| 1821347154 | Shakirah Forde | Counselor | 1770 Indian Trail Lilburn Rd Ste 120, Norcross, GA 30093 | 2012-08-31 |
| Find all providers in zip 30093 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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|---|---|---|---|---|
| 1588149256 | Center for Pan Asian Community Services, Inc. | Clinic/Center | 6185 Buford Hwy Bldg A, Norcross, GA 30071-2350 | 2018-09-28 |
| 1265624548 | Four Corners Primary Care Centers Inc | Clinic/Center | 5300 Oakbrook Pkwy, Suite 130, Norcross, GA 30093-2256 | 2007-08-10 |
| 1336493311 | Center for Pan Asian Community Services, Inc. | Clinic/Center | 6185 Buford Hwy, Building G, Norcross, GA 30071-2350 | 2012-10-30 |
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| 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 |
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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.