| NPI | 1235123993 |
|---|---|
| Former Legal Business Name | SOUTHSIDE HEALTHCARE |
| Entity Type | Organization |
| Authorized Contact | CLAUDIO AZZARITI CFO 404-564-6972 |
| 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 | 2011-03-07 |