# SOUTHSIDE MEDICAL MANAGEMENT INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SOUTHSIDE MEDICAL MANAGEMENT INC
- **Other names:** Kenbridge Family Medicine
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1689090839
- **Legal business name:** SOUTHSIDE MEDICAL MANAGEMENT INC
- **Authorized official:** GRAHAM H POWERS III MD (PARTNER)
- **Authorized official phone:** (434) 584-2000

## Contact information

- **Practice address:** 306 E 6TH AVE, KENBRIDGE, VA 23944-2050
- **Practice address phone:** (434) 676-8021
- **Practice address fax:** (434) 447-2240
- **Mailing address:** 306 E 6TH AVE, KENBRIDGE, VA 23944-2050
- **Mailing address phone:** (434) 676-8021
- **Mailing address fax:** (434) 447-2240

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | 0024168641 | VA | — |
| 363LF0000X | Family Nurse Practitioner | — | VA | — |
| 363LP0200X | Pediatric Nurse Practitioner | 0024168845 | VA | — |

## Other

- **Enumeration date:** 03/12/2014
- **Last updated:** 02/08/2017