| Southside Medical Center, Inc. | |
|
1100 Cleveland Ave Atlanta GA 30344-3602 | |
| (404) 627-1385 | |
| (404) 564-0377 |
| Full Name | Southside Medical Center, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1100 Cleveland Ave, Atlanta, Georgia |
| Authorized Official Name and Position | Claudio Azzariti (CFO) |
| Authorized Official Contact | 4045647009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southside Medical Center, Inc. 1046 Ridge Ave Sw Atlanta GA 30315-1640 Ph: (404) 688-1350 | Southside Medical Center, Inc. 1100 Cleveland Ave Atlanta GA 30344-3602 Ph: (404) 627-1385 |
| NPI Number | 1174641658 |
|---|---|
| Provider Enumeration Date | 03/26/2007 |
| Last Update Date | 06/11/2012 |
| Medicare PECOS PAC ID | 6901700723 |
|---|---|
| Medicare Enrollment ID | O20100929001648 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174641658 | NPI | - | NPPES |
| GRP375 | Other | GA | MEDICARE GROUP |
| 000041764B | Medicaid | GA | |
| 000444056H | Medicaid | GA | |
| 04092 | Other | GA | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Georgia) | Primary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Secondary |
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