Southside Medical Center, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

044293H Issued in GA

Legal business name

SOUTHSIDE MEDICAL CENTER, INC.

Practice address

1514 Cleveland Ave Ste 205
East Point, GA 30344-6965

Phone

(678) 510-0827

Fax

(678) 510-0826

NPI assigned

Jul 25, 2006

Last updated

Jun 10, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Claudio Azzariti, MBA, CPA

Title

Chief Financial Officer

Phone

(404) 688-1350

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276128000000",
    "number": "1245252220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1046 RIDGE AVE SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303151640",
            "telephone_number": "404-688-1350",
            "fax_number": "404-564-0431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 CLEVELAND AVE STE 205",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303446965",
            "telephone_number": "678-510-0827",
            "fax_number": "678-510-0826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2010-06-10",
        "status": "A",
        "authorized_official_last_name": "AZZARITI",
        "authorized_official_first_name": "CLAUDIO",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "404-688-1350",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA, CPA"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "GA",
            "license": "044293H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00064336A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Southwest Atlanta Dialysis Centers LLC (East Point Dialysis Center)
• Southwest Atlanta Medical & Rehab
• Linda Soviravong, PHARMD
• Nawassa Wylette Staples, PT

• Home Health Agency in East Point, GA
• Providers in East Point, GA by specialty
• Home Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.