NPIMap

Organization Active NPI

Southside Medical Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Forest Park, GA
National Provider Identifier
1467325910
Registry record updated Oct 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHSIDE MEDICAL CENTER, INC
Practice address
1260 Rockcut Rd
Forest Park, GA 30297-3630
Phone
(404) 688-1350
NPI assigned
Sep 29, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2025

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

Authorized official

Name
Masresha Kassa, CPA
Title
Cfo
Phone
(404) 564-7009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1260 Rockcut Rd
Forest Park, GA 30297-3630

Mailing address

1260 Rockcut Rd
Forest Park, GA 30297-3630
Phone (404) 688-1350

Other names 1

  • Southside Medical Center School Based Health Center at Huie Elementary School Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251120001249 GA Part A Provider - Federally Qualified Health Center (FQHC) 6901700723 Practice locations: Forest Park, GA

Federally qualified health center certification: CCN C21047

Legal name
SOUTHSIDE MEDICAL CENTER, INC.
Doing business as
SOUTHSIDE MEDICAL CENTER SCHOOL BASED HEALTH CENTER AT HUIE ELEMENTARY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 31, 2025
Last certification
Oct 31, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1260 Rockcut Rd
Forest Park, GA 30297-3630

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Southside Healthcare in18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
David M Williams Individual Corporate DirectorCeo/President Jul 2, 1990
W-2 Managing EmployeeCeo/President Jul 2, 1990
Steve Barnes Individual Corporate OfficerBoard Member Sep 27, 2012
Masresha Kassa Individual Corporate DirectorCfo Apr 1, 2025
W-2 Managing EmployeeCfo Apr 1, 2025
Vaughn a Reid Individual Corporate OfficerBoard Member Sep 27, 2012
Geraldine Elder Individual Corporate OfficerBoard Member Aug 24, 2017
Janis L Ware Individual Corporate OfficerBoard Member Sep 27, 2012

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Suncrest Home HealthAtlanta, GA, CCN 117022 Home health agency 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2021

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1759104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760400000000",
    "number": "1467325910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 ROCKCUT RD",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302973630",
            "telephone_number": "404-688-1350",
            "fax_number": "404-688-2962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 ROCKCUT RD",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302973630",
            "telephone_number": "404-688-1350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-29",
        "last_updated": "2025-10-14",
        "certification_date": "2025-10-14",
        "status": "A",
        "authorized_official_last_name": "KASSA",
        "authorized_official_first_name": "MASRESHA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "404-564-7009",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southside Medical Center School Based Health Center at Huie Elementary School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Forest Park, GA

Sources for this page

Verify at the official NPI Registry.