NPI | 1235123993 |
---|---|
Former Legal Business Name | SOUTHSIDE HEALTHCARE |
Entity Type | Organization |
Authorized Contact | MASRESHA KASSA CFO 404-688-1350 |
Organization Subpart ? | No |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
Enumeration Date | 2005-09-08 |
Last Update Date | 2025-07-09 |