NPI age
15 years
Enumerated 2010-12-07
● Active Type 2 · Organization
Southside Internal Medicine Pc
Southside Internal Medicine Pc is 1 of 655 clinic/center organizations in Georgia.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Okoro
Medical Doctor
Last NPPES update
2015-01-14
Source: monthly bulk 2026-05
How this organization compares
Across 655 active clinic/center providers in Georgia.
NPI age
15 years
↑ 4 yr above median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2010 → 2026
2010-12Enumerated in NPPES
2010
2026
Where they practice
Primary practice location
804 Commerce Blvd, Suite B
Riverdale, GA 302967198
Mailing address
7384 Highway 85
Riverdale, GA 302743453
Authorized official
Casimir Okoro, M.D
Medical Doctor
📞 7709976644
Individual providers at this organization
3 individual providers on file at this primary practice address.
- Willie Cameron, LPC Counselor NPI 1588879803
- Efiong Mbaba, REGISTERED NURSE Durable Medical Equipment & Medical Supplies NPI 1477763654
- April Paulk, CPT, CNA Technician, Pathology NPI 1699591115
Specialties
-
Clinic/Center PrimaryDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 000544948J |
Practice context
Multi-provider organization. 3 individual providers on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.