Organization
SOUTHSIDE MEDICAL MANAGEMENT INC
Active
Parent organization
SOUTHSIDE MEDICAL MANAGEMENT INC
Other names
Kenbridge Family Medicine
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHSIDE MEDICAL MANAGEMENT INC
Authorized official
GRAHAM H POWERS III MD (PARTNER)
(434) 584-2000
Entity
Organization
Contact information
Practice address
306 E 6TH AVE, KENBRIDGE, VA 23944-2050
(434) 676-8021
(434) 447-2240
Mailing address
306 E 6TH AVE, KENBRIDGE, VA 23944-2050
(434) 676-8021
(434) 447-2240
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363LA2200X
Adult Health Nurse Practitioner
0024168641
VA
363LF0000X
Family Nurse Practitioner
—
VA
363LP0200X
Pediatric Nurse Practitioner
0024168845
VA
Other
Enumeration date
03/12/2014
Last updated
02/08/2017
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