| Southside Medical Center, Inc. | |
|
116 Upper Riverdale Rd Sw Riverdale GA 30274 | |
| (678) 834-7847 | |
| (770) 991-0071 |
| Full Name | Southside Medical Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 116 Upper Riverdale Rd Sw, Riverdale, 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. 116 Upper Riverdale Rd Sw Riverdale GA 30274 Ph: (678) 834-7847 |
| NPI Number | 1427175090 |
|---|---|
| Provider Enumeration Date | 03/26/2007 |
| Last Update Date | 05/22/2019 |
| Medicare PECOS PAC ID | 6901700723 |
|---|---|
| Medicare Enrollment ID | O20050505000488 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427175090 | NPI | - | NPPES |
| 000444056L | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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