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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