Healthcare Provider Details

I. General information

NPI: 1891489449
Provider Name (Legal Business Name): BEDSIDE PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 S COBB DR SE
SMYRNA GA
30080-1845
US

IV. Provider business mailing address

2635 S COBB DR SE
SMYRNA GA
30080-1845
US

V. Phone/Fax

Practice location:
  • Phone: 513-633-0088
  • Fax:
Mailing address:
  • Phone: 513-633-0088
  • Fax: 470-462-4408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JABULANI SIDILE
Title or Position: CO-OWNER
Credential: MD
Phone: 513-633-0088