Provider Type Icon

SOUTHSIDE MEDICAL CARE NPI 1376752311


NPI Information

NPI: 1376752311
Provider Name: SOUTHSIDE MEDICAL CARE
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 11D0258293

Address:
6325 SHANNON PKWY
SUITE D
UNION CITY, GA
ZIP 30291
Phone: (770) 964-1400
Get Directions

SOUTHSIDE MEDICAL CARE is a family medicine in Union City, GA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. SOUTHSIDE MEDICAL CARE NPI is 1376752311. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

6325 SHANNON PKWY
SUITE D
UNION CITY, GA
ZIP 30291-538
Phone: (770) 964-1400
Fax: (770) 306-1343

The provider's authorized official is Nicole Quadagno .
The authorized official title is Executive Director and has the following contact phone number (770) 964-1400.

The CLIA number assigned to this NPI record is 11D0258293 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/22/2007 and was last updated on 7/26/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine024000GEORGIANo
2207Q00000XFamily Medicine024221GEORGIANo
3207Q00000XFamily Medicine004096GEORGIANo
4207Q00000XFamily MedicineRN115016GEORGIANo
5207Q00000XFamily Medicine051480GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1P37063MEDICARE UPINGEORGIA
2P99038MEDICARE UPINGEORGIA
3H68344MEDICARE UPINGEORGIA
4D32815MEDICARE UPINGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.