Organization
SOUTHSIDE MEDICAL CENTER, INC.
Active
Organization
SOUTHSIDE MEDICAL CENTER, INC.
Active
Other names
Southside Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MASRESHA KASSA CPA (CFO)
(404) 564-7009
Entity
Organization
Contact information
Practice address
1100 CLEVELAND AVE, ATLANTA, GA 30344-3602
(404) 627-1385
(404) 564-0377
Mailing address
1046 RIDGE AVE SW, ATLANTA, GA 30315-1640
(404) 688-1350
(404) 688-2962
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
GA
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000041764B
—
GA
05
—
000444056H
—
GA
01
—
04092
BCBS
GA
01
—
GRP375
MEDICARE GROUP
GA
Enumeration date
03/26/2007
Last updated
07/09/2025
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