| NPI | 1174641658 |
|---|---|
| Former Legal Business Name | SOUTHSIDE HEALTHCARE |
| Entity Type | Organization |
| Authorized Contact | CLAUDIO AZZARITI CFO 404-564-7009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2012-06-11 |