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General NPI Number Information
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NPI Number | 1467325910
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE MEDICAL CENTER, INC
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 1260 ROCKCUT RD
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City | FOREST PARK
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State | GA
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Zip | 30297-3630
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Country | US
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Telephone | 404-688-1350
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Fax |
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Provider Business Mailing Address
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Address Line | 1260 ROCKCUT RD
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City | FOREST PARK
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State | GA
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Zip | 30297-3630
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Country | US
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Telephone | 404-688-1350
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Fax | 404-688-2962
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Authorized Official
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Title or Position | CFO
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Name | MASRESHA KASSA
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Credential | CPA
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Telephone | 404-564-7009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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