Organization Active NPI

Conyers Internal Medicine LLC

  • Internal Medicine Physician
  • Conyers, GA
National Provider Identifier
1063752913
Registry record updated Oct 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CONYERS INTERNAL MEDICINE LLC
Practice address
1805 Honey Creek CMNS SE Ste C
Conyers, GA 30013-5829
Phone
(770) 918-2555
Fax
(770) 648-7617
NPI assigned
Feb 28, 2013
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
Naseem K Shakoor, MDNPI 1821109463
Title
Owner
Phone
(770) 918-2555

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
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X GA Primary

Addresses

Primary practice location

1805 Honey Creek CMNS SE Ste C
Conyers, GA 30013-5829

Mailing address

1805 Honey Creek CMNS SE Ste C
Conyers, GA 30013-5829
Phone (770) 918-2555

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130326000232 GA Part B Supplier - Clinic/Group Practice 0042455974 Receives reassigned benefits from 1 practitioner
Practice locations: Conyers, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0979241Conyers Internal Medicine1805 Honey Creek Commons, Suite C, Conyers, GA 30013Certificate of waiverJan 8, 2027

National Provider Directory

National Provider Directory

Locations

1380 Milstead Ave NE
Ste C
Conyers, GA 30012
Phone (770) 918-2310

1805 Honey Creek Cmns SE
Ste C
Conyers, GA 30013
Phone (770) 918-2555

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1362009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1793145600000",
    "number": "1063752913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 HONEY CREEK CMNS SE STE C",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300135829",
            "telephone_number": "770-918-2555",
            "fax_number": "770-648-7617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 HONEY CREEK CMNS SE STE C",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300135829",
            "telephone_number": "770-918-2555",
            "fax_number": "770-648-7617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONYERS INTERNAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-28",
        "last_updated": "2026-10-28",
        "certification_date": "2026-10-28",
        "status": "A",
        "authorized_official_last_name": "SHAKOOR",
        "authorized_official_first_name": "NASEEM",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-918-2555",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "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.