| NPI | 1073177978 |
|---|---|
| Former Legal Business Name | SOUTHSIDE MEDICAL PRACTICE |
| Entity Type | Organization |
| Authorized Contact | TAMMY ATKINS Practice Manager 434-392-9438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2022-07-13 |