Organization
SOUTHSIDE MEDICAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE QUADAGNO (EXECUTIVE DIRECTOR)
(770) 964-1400
Entity
Organization
Contact information
Practice address
6325 SHANNON PKWY, SUITE D, UNION CITY, GA 30291-1538
(770) 964-1400
(770) 306-1343
Mailing address
6325 SHANNON PKWY, SUITE D, UNION CITY, GA 30291-1538
(770) 964-1400
(770) 306-1343
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
004096
GA
207Q00000X
Family Medicine Physician
024000
GA
207Q00000X
Family Medicine Physician
024221
GA
207Q00000X
Family Medicine Physician
Primary
051480
GA
207Q00000X
Family Medicine Physician
RN115016
GA
Other
Enumeration date
05/22/2007
Last updated
07/26/2012
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