NPIMap

Organization Active NPI

Southside Medical Center, Inc

Doing business as Southside Medical Center School Based Health Center at Lee Elementary School

  • Federally Qualified Health Center (FQHC)
  • Jonesboro, GA
National Provider Identifier
1821981234
Registry record updated Oct 17, 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
Doing business as
Southside Medical Center School Based Health Center at Lee Elementary School
Practice address
178 Lee St
Jonesboro, GA 30236-3524
Phone
(404) 688-1350
NPI assigned
Jun 3, 2025
Last updated
Oct 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2025

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

Authorized official

Name
Mr. Masresha Kassa, CPA
Title
Cfo
Phone
(404) 688-1350

Specialties & licenses 1

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

Addresses

Primary practice location

178 Lee St
Jonesboro, GA 30236-3524

Mailing address

PO Box 6687
Atlanta, GA 30315-0687
Phone (404) 688-1350

Other names 1

  • Southside Medical Center School Based Health Center at Lee 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
O20251126003694 GA Part A Provider - Federally Qualified Health Center (FQHC) 6901700723 Practice locations: Jonesboro, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821981234. Details of each certification follow.

Federally qualified health center certification: CCN C21049

Legal name
SOUTHSIDE MEDICAL CENTER, INC.
Doing business as
SOUTHSIDE MEDICAL CENTER SCHOOL BASED HEALTH CENTER AT LEE ELEMENTARY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 26, 2025
Last certification
Nov 26, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
178 Lee St
Jonesboro, GA 30236-3524

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
Healthsouth Inc Lab18 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

Locations

2685 Metropolitan Pkwy SW
Ste C
Atlanta, GA 30315
Phone (404) 564-0377

660 McWilliams Rd SE
Atlanta, GA 30315
Phone (678) 974-8148

1100 Cleveland Ave
East Point, GA 30344
Phone (404) 564-6784

1260 Rockcut Rd
Forest Park, GA 30297

4140 Jonesboro Rd
Ste D1
Forest Park, GA 30297
Phone (404) 608-7123

176 Lyons St
Jackson, GA 30233
Phone (770) 504-5566

178 Lee St
Jonesboro, GA 30236

1030 Old Peachtree Rd NW
Ste 402
Lawrenceville, GA 30043
Phone (770) 495-6222

5127 Jimmy Carter Blvd
Ste 205
Norcross, GA 30093
Phone (770) 368-3845

5139 Jimmy Carter Blvd
Norcross, GA 30093
Phone (770) 613-0070

275 Upper Riverdale Rd SW
Ste D
Riverdale, GA 30274
Phone (248) 770-3658

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.

Practitioners & affiliated clinicians

Practitioners 106

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 106

NPI Registry JSON

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

{
    "created_epoch": "1748908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760659200000",
    "number": "1821981234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6687",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303150687",
            "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": "178 LEE ST",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302363524",
            "telephone_number": "404-688-1350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-03",
        "last_updated": "2025-10-17",
        "certification_date": "2025-10-17",
        "status": "A",
        "authorized_official_last_name": "KASSA",
        "authorized_official_first_name": "MASRESHA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "404-688-1350",
        "authorized_official_name_prefix": "Mr.",
        "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 Lee Elementary School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jonesboro, GA

Sources for this page

Verify at the official NPI Registry.