| Southside Medical Care | |
|
6325 Shannon Pkwy Suite D Union City GA 30291-1538 | |
| (770) 964-1400 | |
| (770) 306-1343 |
| Full Name | Southside Medical Care |
|---|---|
| Speciality | Family Medicine |
| Location | 6325 Shannon Pkwy, Union City, Georgia |
| Authorized Official Name and Position | Nicole Quadagno (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7709641400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southside Medical Care 6325 Shannon Pkwy Suite D Union City GA 30291-1538 Ph: (770) 964-1400 | Southside Medical Care 6325 Shannon Pkwy Suite D Union City GA 30291-1538 Ph: (770) 964-1400 |
| NPI Number | 1376752311 |
|---|---|
| Provider Enumeration Date | 05/22/2007 |
| Last Update Date | 07/26/2012 |
| Medicare PECOS PAC ID | 9931180650 |
|---|---|
| Medicare Enrollment ID | O20040528000037 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376752311 | NPI | - | NPPES |
| Provider Name | Kenneth E Jones |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1417018920 PECOS PAC ID: 2365429396 Enrollment ID: I20040707000571 |
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