Organization
SOUTHSIDE MEDICAL CENTER, INC.
Active
Other names
Southside Medical Center - Jackson Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID M WILLIAMS M.D. (CEO)
(404) 688-1350
Entity
Organization
Contact information
Practice address
176 LYONS ST, JACKSON, GA 30233-2134
(404) 688-1350
(404) 688-2962
Mailing address
1046 RIDGE AVE SW, ATLANTA, GA 30315-1640
(404) 688-1350
(404) 688-2962
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000444056O
—
GA
Enumeration date
02/04/2014
Last updated
09/14/2015
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