SOUTHSIDE MEDICAL CENTER, INC. (NPI# 1962529529) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962529529 |
| Entity Type | Organization |
| Organization Name | SOUTHSIDE MEDICAL CENTER, INC. |
| Other Organization Name | SOUTHSIDE HEALTHCARE |
| Practice Address |
2201 Talmadge Rd Hampton GA 30228-1608 |
| Mailing Address |
1046 Ridge Ave Sw Atlanta GA 30315-1640 |
| Practice Telephone | 6785934666 |
| Mailing Telephone | 4046881350 |
| Mailing Fax Number | 4046882962 |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2013-06-19 |
| Authorized Official Name | CLAUDIO AZZARITI (CFO) |
| Authorized Official Telephone | 4045647009 |
| 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 | 000444056K | 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 |
| 1922125574 | Southside Medical Center, Inc. | Clinic/Center | 5127 Jimmy Carter Blvd, Norcross, GA 30093-1619 | 2007-03-26 |
| Street Address |
2201 TALMADGE RD |
| City | HAMPTON |
| State | GA |
| Zip Code | 30228-1608 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487641627 | Jose Luis Fernandez | Internal Medicine | 2201 Talmadge Rd, Hampton, GA 30228-1608 | 2005-10-03 |
| 1558583658 | Obiajulu C. Okafor | Internal Medicine | 2201 Talmadge Rd, Hampton, GA 30228-1608 | 2007-05-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679196166 | Mutinta Matimba Hamuwele | Nurse Practitioner | 10988 Genova Ter, Hampton, GA 30228 | 2020-05-19 |
| 1487295044 | Living Testimony Homecare, LLC | Home Health | 10833 Southwood Drive, Hampton, GA 30228 | 2019-10-04 |
| 1598246878 | Emma Ledbetter | Nurse Practitioner | 1910 Elm Park Dr, Hampton, GA 30228 | 2018-08-24 |
| 1720506231 | O'reilly Comprehensive Dermatology, Inc. | Dermatology | 755 Mount Vernon Hwy., Suite 330, Atlanta, GA 30228 | 2017-09-05 |
| 1720500648 | Sophia Demetria Edwards | Home Health Aide | 2059 Grove Way, Hampton, GA 30228 | 2017-07-12 |
| 1083143432 | Ciera Jayna Scales | Dentist | 144 Revolutionary Dr, Hampton, GA 30228 | 2017-06-08 |
| 1811446438 | Alwarna Pasteur | Contractor | 1419 Hyde Court, Hampton, GA 30228 | 2016-09-23 |
| 1932599370 | Corlyn Doolittle | Speech-Language Pathologist | 412 Lakeside Villa Dr, Lovejoy, GA 30228 | 2015-01-23 |
| 1114367596 | Mayer Counseling Services,llc | Counselor | 591 Toronto Circle, Hampton, GA 30228 | 2013-06-28 |
| 1932544269 | Eye Can See Eyewear Inc. | Technician/Technologist | 22 E. Main St. N., Hampton, GA 30228 | 2013-04-30 |
| Find all providers in zip 30228 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 1417597238 | The Family Health Centers of Georgia, Inc | Clinic/Center | 19 John Maddox Dr Nw Ste B, Rome, GA 30165-1477 | 2020-01-09 |
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| 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.