NPIMap

Organization Active NPI

Eastside Endoscopy Center LLC

  • Ambulatory Surgical Clinic/Center
  • Conyers, GA
National Provider Identifier
1053846592
Registry record updated Oct 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
EASTSIDE ENDOSCOPY CENTER LLC
Practice address
1805 Honey Creek CMNS SE
Conyers, GA 30013-5828
Phone
(404) 509-1868
Fax
(770) 809-3667
NPI assigned
Apr 21, 2017
Last updated
Oct 28, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Karim Shakoor, MDNPI 1952412579
Title
Medical Director
Phone
(770) 922-7000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

1805 Honey Creek CMNS SE
Conyers, GA 30013-5828

Mailing address

1805 Honey Creek CMNS SE Ste a
Conyers, GA 30013-5829
Phone (770) 922-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171005002499 GA Part B Supplier - Ambulatory Surgical Center 4981971173 Practice locations: Conyers, GA

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Eastside Endoscopy Center LLCCCN 11C0001471
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

1805 Honey Creek Cmns SE
Conyers, GA 30013
Phone (770) 761-0501

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1492732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1793145600000",
    "number": "1053846592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 HONEY CREEK CMNS SE STE A",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300135829",
            "telephone_number": "770-922-7000",
            "fax_number": "770-809-3667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 HONEY CREEK CMNS SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300135828",
            "telephone_number": "404-509-1868",
            "fax_number": "770-809-3667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE ENDOSCOPY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-21",
        "last_updated": "2026-10-28",
        "certification_date": "2026-10-28",
        "status": "A",
        "authorized_official_last_name": "SHAKOOR",
        "authorized_official_first_name": "KARIM",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "770-922-7000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.