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Contact Information

EASTSIDE INTERNAL MEDICINE, LLC
2080 EASTSIDE DR
SUITE A
CONYERS, GA30013-1953
 Phone: 678-625-7800
 Fax: 678-625-7888
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Legal Medicine

173000000X
Indicates primary specialty

NPI Profile & details for EASTSIDE INTERNAL MEDICINE, LLC

NPI Number 1932256526
LBN Legal business name EASTSIDE INTERNAL MEDICINE, LLC
Authorized official HENRIETTA MADDOX - (OFFICE MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 01/04/2007
Last updated 07/21/2022 - About 4 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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