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SOUTHSIDE MEDICAL PRACTICE PLLC
NPI 1073177978
Internal Medicine in Farmville, VA

Active since April 25, 2019CLIA 49D2167061 · Waiver
502 BEECH ST, FARMVILLE, VA 23901(434) 392-9438(434) 392-7630 Get Directions Write a Review

NPPES record last updated: July 13, 2022. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Jul 13, 2022, Feb 3, 2021, Jan 21, 2021 and 1 more (4 updates tracked since 2019).

About Southside Medical Practice Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHSIDE MEDICAL PRACTICE PLLC (NPI 1073177978), doing business as Southside Medical Practice, is a healthcare organization registered as an internal medicine in Farmville, Virginia and active in the NPI registry since April 2019. The organization holds a CLIA Waiver certificate valid through May 30, 2027 and lists Tammy Atkins, Practice Manager, as its authorized official.

NPPES Registry Identity

NPI1073177978
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameSOUTHSIDE MEDICAL PRACTICE PLLC
Location Address502 BEECH STFarmville, VA 23901-1222
Mailing Address502 Beech StFarmville, VA 23901-1222 · (434) 392-9438 · Fax (434) 392-7630
Phone(434) 392-9438
Fax(434) 392-7630
Organization SubpartNo
Authorized OfficialTammy AtkinsPractice Manager · (434) 392-9438
Enumeration DateApril 25, 2019
Last NPPES UpdateJuly 13, 20224 updates tracked since enumeration
NPPES CertifiedJuly 13, 2022
✔ NPI 1073177978 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
502 BEECH ST, Farmville, VA 23901
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Other Names 1

Former Legal Business NameSouthside Medical Practice

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D2167061

Southside Medical Practice · Farmville, VA
Active · expires May 30, 2027
CLIA Number49D2167061
Laboratory TypePhysician Office
Certificate Effective DateMay 31, 2025
Certificate Expiration DateMay 30, 2027
Laboratory DirectorVictor R. Adaniel
Laboratory Phone(434) 392-9438
Laboratory LocationSouthside Medical Practice502 Beech Street, Farmville, VA 23901
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. VICTOR ROMEO CLEMENTE ADANIEL MD
Internal Medicine
502 BEECH ST
FARMVILLE, VA 23901
Prince Edward County (434) 392-9438
TERESA GAIL GEORGE LPC
Behavior Analyst
502 BEECH ST
FARMVILLE, VA 23901
Prince Edward County (434) 414-8308
TERESITA CAPATI DIONISIO M.D.
Pediatrics
502 BEECH ST
FARMVILLE, VA 23901
Prince Edward County (434) 392-9438

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southside Medical Practice PLLC's NPI number?

The NPI number for Southside Medical Practice PLLC is 1073177978. It was assigned to this organization in the NPPES registry on April 25, 2019. The provider was formerly known as Southside Medical Practice.

Where is Southside Medical Practice PLLC located?

Southside Medical Practice PLLC is located at 502 Beech St, Farmville, VA 23901. The listed phone number is (434) 392-9438.

What is Southside Medical Practice PLLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Southside Medical Practice PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D2167061) is associated with this NPI, valid through May 30, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Southside Medical Practice PLLC was last updated on July 13, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.