# SOUTHSIDE MEDICAL CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376752311
- **Authorized official:** NICOLE QUADAGNO (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (770) 964-1400

## Contact information

- **Practice address:** 6325 SHANNON PKWY, SUITE D, UNION CITY, GA 30291-1538
- **Practice address phone:** (770) 964-1400
- **Practice address fax:** (770) 306-1343
- **Mailing address:** 6325 SHANNON PKWY, SUITE D, UNION CITY, GA 30291-1538
- **Mailing address phone:** (770) 964-1400
- **Mailing address fax:** (770) 306-1343

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 004096 | GA | — |
| 207Q00000X | Family Medicine Physician | 024000 | GA | — |
| 207Q00000X | Family Medicine Physician | 024221 | GA | — |
| 207Q00000X | Family Medicine Physician | 051480 | GA | Yes |
| 207Q00000X | Family Medicine Physician | RN115016 | GA | — |

## Other

- **Enumeration date:** 05/22/2007
- **Last updated:** 07/26/2012