SOUTHSIDE INTERNAL MEDICINE PC (NPI# 1740583194) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740583194 |
| Entity Type | Organization |
| Organization Name | SOUTHSIDE INTERNAL MEDICINE PC |
| Practice Address |
804 Commerce Blvd Suite B Riverdale GA 30296-7198 |
| Mailing Address |
7384 Highway 85 Riverdale GA 30274-3453 |
| Practice Telephone | 7709976644 |
| Practice Fax Number | 7709976630 |
| Mailing Telephone | 7709976644 |
| Mailing Fax Number | 7709976630 |
| Enumeration Date | 2010-12-07 |
| Last Update Date | 2015-01-14 |
| Authorized Official Name | DR. CASIMIR OKORO (MEDICAL DOCTOR) |
| Authorized Official Telephone | 7709976644 |
| Authorized Official Credential | M.D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000544948J | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578602694 | Southside Internal Medicine PC | Internal Medicine | 8778 Madison Ave, Ste 100, Indianapolis, IN 46227-7204 | 2007-02-05 |
| Street Address |
804 COMMERCE BLVD SUITE B |
| City | RIVERDALE |
| State | GA |
| Zip Code | 30296-7198 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588879803 | Willie Roy Cameron | Counselor | 804 Commerce Blvd, Ste-a12-14, Riverdale, GA 30296-7198 | 2007-05-11 |
| 1790959187 | Maxicare Medical Supply | Durable Medical Equipment & Medical Supplies | 804 Commerce Blvd, Suite A-32, Riverdale, GA 30296-7198 | 2008-04-16 |
| 1417134636 | L.t. Exams, Inc | Clinical Medical Laboratory | 804 Commerce Blvd, Ste D, Riverdale, GA 30296-7198 | 2008-01-30 |
| 1730361775 | House of Inspiration Group Home, Inc | Community/Behavioral Health | 804 Commerce Blvd, Suite A2, Riverdale, GA 30296-7198 | 2007-12-01 |
| 1477763654 | Efiong E. Mbaba | Durable Medical Equipment & Medical Supplies | 804 Commerce Blvd, Suite A-32, Riverdale, GA 30296-3321 | 2007-05-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417558594 | James D Hickman | Home Health Aide | 2252 Addison Park, Riverdale, GA 30296 | 2020-11-04 |
| 1255973251 | Octavia Bostic | Nurse's Aide | 7670 Creekside Lane, Riverdale, GA 30296 | 2019-10-10 |
| 1548746829 | Verna Stoner-frazier | Physical Therapist | 1542 Bethaven Rd, Riverdale, GA 30296 | 2018-07-19 |
| 1346762705 | Letty Searcy | Case Manager/Care Coordinator | 7125 E. Village Ct, Riverdale, GA 30296 | 2017-07-07 |
| 1225402639 | Optima Physical Therapy Services | Clinic/Center | 808 Commerce Boulevard, Riverdale, GA 30296 | 2015-11-23 |
| 1437409224 | Mobile Nursing Service LLC | Nursing Care | 829 Scott Rd, Riverdale, GA 30296 | 2012-09-19 |
| 1104069517 | Taina S. Holly | Licensed Practical Nurse | 1234 Elgin Way, Riverdale, GA 30296 | 2009-04-15 |
| 1386720118 | Absolute Healthcare & Rehab Center | Chiropractor | 1807 Hwy 138 Sw, Riverdale, GA 30296 | 2006-10-27 |
| 1467558650 | Daniel Tesfa Redie | Dentist | 1849 Hwy 138, Riverdale, GA 30296 | 2006-09-15 |
| 1033214184 | Malcolm Hill | Chiropractor | 1296 Hwy 138, Suite 105, Riverdale, GA 30296 | 2006-09-13 |
| Find all providers in zip 30296 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952457665 | Maurice Fouad Naccache | Clinic/Center | 6201 Riverdale Rd, Suite 101, Riverdale, MD 20737-2150 | 2007-01-26 |
| 1447255609 | Edge Medical Care PC | Clinic/Center | 5305 Kenilworth Ave, Ste 100, Riverdale, MD 20737-3110 | 2005-06-15 |
| 1902200447 | Pediatric Clinic, PC | Clinic/Center | 189 Medical Way, Suite C, Riverdale, GA 30274-4905 | 2014-10-13 |
| 1609077684 | Valley Family Health Center | Clinic/Center | 3567 W Mt Whitney Ave, Riverdale, CA 93656 | 2007-05-29 |
| 1346459286 | Central Valley Maternal & Child Care Centers | Clinic/Center | 3567 W. Mt. Whitney Ave., Riverdale, CA 93656 | 2007-05-21 |
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|---|---|---|---|---|
| 1942809108 | Lexington Primary Care LLC | Clinic/Center | 777 Athens Rd, Lexington, GA 30648-1902 | 2020-10-20 |
| 1619575834 | The Iv Spot, LLC. | Clinic/Center | 2100 Parklake Dr Ne # C-5, Atlanta, GA 30345-2824 | 2020-10-09 |
| 1528673514 | Safe Haven Medical Services | Clinic/Center | 444 Racetrack Rd, Mcdonough, GA 30252-6837 | 2020-09-15 |
| 1780296533 | North Atlanta Mental Wellness | Clinic/Center | 1742 Mount Vernon Rd Ste 150b, Atlanta, GA 30338-4251 | 2020-08-21 |
| 1639788136 | Walker Health and Wellness LLC | Clinic/Center | 111 Bradford Dr, Bloomingdale, GA 31302-4926 | 2020-07-30 |
| 1942827332 | Primary Care of Coastal Georgia | Clinic/Center | 214a Professional Cir, St Marys, GA 31558 | 2020-07-01 |
| 1598389637 | Mercie Health | Clinic/Center | 3721 New Macland Rd Ste 246, Powder Springs, GA 30127-2000 | 2020-06-04 |
| 1366061699 | Beyondmed LLC | Clinic/Center | 1820 Willow Branch Ln Nw, Kennesaw, GA 30152-4558 | 2020-04-16 |
| 1366082596 | Rock Health Inc | Clinic/Center | 5385 Five Forks Trickum Rd Ste F, Stone Mountain, GA 30087-3018 | 2020-01-15 |
| 1477192219 | Meridian Corporate Healthcare of Georgia P C | Clinic/Center | 5163 Thompson Bridge Rd, Murrayville, GA 30564-1930 | 2019-12-26 |
| 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.