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SOUTHSIDE OB/GYN P.C. NPI 1407024557


NPI Information

NPI: 1407024557
Provider Name: SOUTHSIDE OB/GYN, P.C.
Classification: Obstetrics & Gynecology - 207V00000X
Entity Type: Organization

CLIA Number: 11D0264467

Address:
9390 FORD AVE
SUITE 4
RICHMOND HILL, GA
ZIP 31324
Phone: (912) 756-3404
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SOUTHSIDE OB/GYN, P.C. is an obstetrics gynecology in Richmond Hill, GA. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. SOUTHSIDE OB/GYN, P.C. NPI is 1407024557. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

9390 FORD AVE
SUITE 4
RICHMOND HILL, GA
ZIP 31324-421
Phone: (912) 756-3404
Fax: (912) 756-6352

The provider's authorized official is Francisco A. Dueno .
The authorized official title is President and has the following contact phone number (912) 656-3533.

The CLIA number assigned to this NPI record is 11D0264467 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 2/12/2008 and was last updated on 3/22/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207V00000XObstetrics & GynecologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1GRP109MEDICARE PINGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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