Southside Pediatrics

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

042292 Issued in GA

Legal business name

SOUTHSIDE PEDIATRICS

Practice address

151 North Park Trail
Suite a
Stockbridge, GA 30281-7373

Phone

(678) 565-3300

Fax

(678) 565-3311

NPI assigned

May 21, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Ravi S Iyer, MD

Title

President

Phone

(678) 565-3300

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carlos A Bruno, MD

  • Pediatrics Physician
  • Broussard, LA
  • NPI 1538153135
  NPD (past)

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287014400000",
    "number": "1659580215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 NORTH PARK TRAIL",
            "address_2": "SUITE A",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817373",
            "telephone_number": "678-565-3300",
            "fax_number": "678-565-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 NORTH PARK TRAIL",
            "address_2": "SUITE A",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817373",
            "telephone_number": "678-565-3300",
            "fax_number": "678-565-3311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2010-10-14",
        "status": "A",
        "authorized_official_last_name": "IYER",
        "authorized_official_first_name": "RAVI",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-565-3300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "042292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southern Medical Clinic LLC
• Southern Medical Clinic, LLC
• Southside Behavioral Health, Inc. (Behavioral Healthcare Solutions, Inc.)
• Southside Kidney Clinics, PC
• Southside Medical Center, Inc (Southside Medical Center -Stockbridge)
• Southside Psychiatric Associates, P.C.
• Southside Psychiatric Associates, P.C.
• Southside Surgical Assistants, LLC
• Speech Blossoms LLC
• Emelda Louise Speeks

• Pediatrics Physician in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 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.