Provider Demographics
NPI:1952489510
Name:SOUTHSIDE FAMILY PRACTICE, P.A.
Entity Type:Organization
Organization Name:SOUTHSIDE FAMILY PRACTICE, P.A.
Other - Org Name:SOUTHSIDE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-735-1880
Mailing Address - Street 1:230 BEISER BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7793
Mailing Address - Country:US
Mailing Address - Phone:302-735-1880
Mailing Address - Fax:302-735-1884
Practice Address - Street 1:230 BEISER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7793
Practice Address - Country:US
Practice Address - Phone:302-735-1880
Practice Address - Fax:302-735-1884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty