| Southside Medical Center - Jackson Clinic | |
|
176 Lyons St Jackson GA 30233-2134 | |
| (404) 688-1350 | |
| (404) 688-2962 |
| Full Name | Southside Medical Center - Jackson Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 176 Lyons St, Jackson, Georgia |
| Authorized Official Name and Position | David M Williams (CEO) |
| Authorized Official Contact | 4046881350 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southside Medical Center - Jackson Clinic 1046 Ridge Ave Sw Atlanta GA 30315-1640 Ph: (404) 688-1350 | Southside Medical Center - Jackson Clinic 176 Lyons St Jackson GA 30233-2134 Ph: (404) 688-1350 |
| NPI Number | 1588088025 |
|---|---|
| Provider Enumeration Date | 02/04/2014 |
| Last Update Date | 09/14/2015 |
| Medicare PECOS PAC ID | 6901700723 |
|---|---|
| Medicare Enrollment ID | O20140707001385 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588088025 | NPI | - | NPPES |
| 000444056O | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
The Doctor's Office, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 261 Brookwood Ave, Jackson, GA 30233 Phone: 678-752-0555 Fax: 678-752-0556 | |
Carol M. Odegaard, Md, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 261 Brookwood Ave, Jackson, GA 30233 Phone: 678-752-0555 Fax: 678-752-0556 | |
Aylo Health, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1502 Highway 16 E, Jackson, GA 30233 Phone: 678-774-0430 Fax: 770-775-3410 | |
Bennie R White Jr Md Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 794 Mcdonough Rd, Suite 105, Jackson, GA 30233 Phone: 770-775-2341 Fax: 770-775-3668 | |
Sylvan Grove Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1050 Mcdonough Rd, Jackson, GA 30233 Phone: 770-775-7861 Fax: 770-775-4478 | |
Maldonado & Moreno, Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 375 Mcdonough Rd, Jackson, GA 30233 Phone: 770-775-4622 |