Organization
SOUTHSIDE MEDICAL CENTER, INC.
Active
Other names
Southside Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
CLAUDIO AZZARITI (CFO)
(404) 564-7009
Entity
Organization
Contact information
Practice address
116 UPPER RIVERDALE RD SW, RIVERDALE, GA 30274
(678) 834-7847
(770) 991-0071
Mailing address
1046 RIDGE AVE SW, ATLANTA, GA 30315-1640
(404) 688-1350
(404) 688-2962
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000444056L
—
GA
Enumeration date
03/26/2007
Last updated
05/22/2019
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