Organization
SOUTHSIDE INTERNAL MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CASIMIR OKORO M.D (MEDICAL DOCTOR)
(770) 997-6644
Entity
Organization
Contact information
Practice address
804 COMMERCE BLVD, SUITE B, RIVERDALE, GA 30296-7198
(770) 997-6644
(770) 997-6630
Mailing address
7384 HIGHWAY 85, RIVERDALE, GA 30274-3453
(770) 997-6644
(770) 997-6630
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000544948J
—
GA
Enumeration date
12/07/2010
Last updated
01/14/2015
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