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NPI Code Detail

MEDICARE: SOUTHSIDE MEDICAL CARE

MEDICARE: SOUTHSIDE MEDICAL CARE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician024000GA
2207Q00000XFamily Medicine Physician024221GA
3207Q00000XFamily Medicine Physician004096GA
4207Q00000XFamily Medicine PhysicianRN115016GA
5207Q00000XFamily Medicine Physician051480GA

General Provider Information

NPI Number : 1376752311
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHSIDE MEDICAL CARE
Provider Business Mailing Address
First Line : 6325 SHANNON PKWY
Second Line : SUITE D
City : UNION CITY
State : GA
Zip : 30291-1538
Country : US
Telephone Number : 770-964-1400
Fax Number : 770-306-1343
Provider Business Practice Location Address
First Line : 6325 SHANNON PKWY
Second Line : SUITE D
City : UNION CITY
State : GA
Zip : 30291-1538
Country : US
Telephone Number : 770-964-1400
Fax Number : 770-306-1343
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : NICOLE QUADAGNO
Credential :
Telephone Number : 770-964-1400
Provider Enumeration Date : 05/22/2007
Last Update Date : 07/26/2012

Similar Medicare Providers

1417018920 — DR. KENNETH E JONES M.D.
Practice Location Address:
6325 SHANNON PKWY , SUITE D
UNION CITY, GA
30291-1538
Practice Phone: 770-964-1400
Practice Fax: 678-815-1248
1205997624 — DR. JON P COX D.O.
Practice Location Address:
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UNION CITY, GA
30291-1538
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Practice Fax: 678-815-1248
1780745554 — KELLY RUSSIN PA
Practice Location Address:
6325 SHANNON PKWY , SUITE D
UNION CITY, GA
30291-1538
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Practice Fax: 770-306-1343
1841439387 — MRS. MEGAN W WALPOLE PAC
Practice Location Address:
6325 SHANNON PKWY , SUITE D
UNION CITY, GA
30291-1538
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Practice Fax: 770-306-1343
1972730562 — SOUTHSIDE MEDICAL CARE II LLC
Practice Location Address:
6325 SHANNON PKWY , SUITE D
UNION CITY, GA
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Practice Fax: 404-943-0209
1720779986 — MELISSA SMITH PA-C
Practice Location Address:
6325 SHANNON PKWY
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30291-1538
Practice Phone: 470-615-7864
Practice Fax:

Directions to “SOUTHSIDE MEDICAL CARE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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