Southside Internal Medicine Pc

LBN: Southside Internal Medicine Pc
Southside Internal Medicine Pc is an health care organization with primary practice located at 804 Commerce Blvd Suite B, Riverdale GA 30296-7198. The organization recently has only one registered license in Ambulatory Health Care Facilities / Primary Care, which is considered as the primary health care specialty. Southside Internal Medicine Pc can be contacted via phone (770) 997-6644, or through Okoro, Casimir via phone (770) 997-6644.

Contact Information

Primary practice address
804 Commerce Blvd Suite B Riverdale GA 30296-7198
Phone: (770) 997-6644
Fax: (770) 997-6630
Website:
Map and Directions
Authorized official contact:
Name: Okoro, Casimir Doctor of Medicine (MD)
Phone: (770) 997-6644

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Primary Care 261QP2300X

Profile Details

NPI number 1740583194
LBN Legal business name Southside Internal Medicine Pc
DBA Doing business as
Authorized official Okoro, Casimir Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Dec 7th, 2010
Last updated Jan 14th, 2015 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740583194 NPPES
Georgia MEDICAID 000544948J

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