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SOUTHSIDE INTERNAL MEDICINE PC
NPI 1740583194
Clinic/Center - Primary Care in Riverdale, GA

Active since December 07, 2010CLIA 11D0980346 · Waiver
804 COMMERCE BLVD, SUITE B, RIVERDALE, GA 30296(770) 997-6644(770) 997-6630 Get Directions Write a Review

NPPES record last updated: January 14, 2015. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Southside Internal Medicine Pc NPPES

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

SOUTHSIDE INTERNAL MEDICINE PC (NPI 1740583194) is a healthcare organization registered as a primary care in Riverdale, Georgia and active in the NPI registry since December 2010. The organization holds a CLIA Waiver certificate valid through November 16, 2026 and lists Casimir Okoro, Medical Doctor, as its authorized official.

NPPES Registry Identity

NPI1740583194
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameSOUTHSIDE INTERNAL MEDICINE PC
Location Address804 COMMERCE BLVD, SUITE BRiverdale, GA 30296-7198
Mailing Address7384 Highway 85Riverdale, GA 30274-3453 · (770) 997-6644 · Fax (770) 997-6630
Phone(770) 997-6644
Fax(770) 997-6630
Organization SubpartNo
Authorized OfficialCasimir OkoroMedical Doctor · (770) 997-6644
Enumeration DateDecember 7, 2010
Last NPPES UpdateJanuary 14, 2015
✔ NPI 1740583194 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
804 COMMERCE BLVD, Riverdale, GA 30296
Open in Google Maps ↗

Other Identifiers 3

Medicare PIN11BDSMZ
Medicare UPINF59027
Medicaid000544948JGA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.Insurance ›

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 11D0980346

Southside Internal Medicine PC · Riverdale, GA
Active · expires Nov 16, 2026
CLIA Number11D0980346
Laboratory TypePhysician Office
Certificate Effective DateNovember 17, 2024
Certificate Expiration DateNovember 16, 2026
Laboratory DirectorCasimir C. Okoro MD
Laboratory Phone(770) 997-6644
Laboratory LocationSouthside Internal Medicine PC7384 Highway 85, Riverdale, GA 30274
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 7

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

L.T. EXAMS, INC
Clinical Medical Laboratory
804 COMMERCE BLVD, STE D
RIVERDALE, GA 30296
Clayton County (770) 996-4724
MR. EFIONG E. MBABA REGISTERED NURSE
Durable Medical Equipment & Medical Supplies
804 COMMERCE BLVD, SUITE A-32
RIVERDALE, GA 30296
Clayton County (770) 907-0194
MR. WILLIE ROY CAMERON LPC
Counselor (Professional)
804 COMMERCE BLVD, STE-A12-14
RIVERDALE, GA 30296
Clayton County (770) 994-8960
FIELD LABS DIAGNOSTICS
Clinical Medical Laboratory
804 COMMERCE BLVD
RIVERDALE, GA 30296
Clayton County (404) 452-2817
MS. APRIL PAULK CPT, CNA
Technician, Pathology (Phlebotomy)
804 COMMERCE BLVD
RIVERDALE, GA 30296
Clayton County (404) 452-2817
HOUSE OF INSPIRATION GROUP HOME, INC
Community/Behavioral Health
804 COMMERCE BLVD, SUITE A2
RIVERDALE, GA 30296
Clayton County (678) 479-7040
MAXICARE MEDICAL SUPPLY
Durable Medical Equipment & Medical Supplies
804 COMMERCE BLVD, SUITE A-32
RIVERDALE, GA 30296
Clayton County (770) 907-0194

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 Internal Medicine PC's NPI number?

The NPI number for Southside Internal Medicine PC is 1740583194. It was assigned to this organization in the NPPES registry on December 7, 2010.

Where is Southside Internal Medicine PC located?

Southside Internal Medicine PC is located at 804 Commerce Blvd Suite B, Riverdale, GA 30296. The listed phone number is (770) 997-6644.

What is Southside Internal Medicine PC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Southside Internal Medicine PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D0980346) is associated with this NPI, valid through November 16, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Southside Internal Medicine PC accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Southside Internal Medicine PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Southside Internal Medicine PC was last updated on January 14, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.