Eastside Urology

Primary specialty

Urology PhysicianTaxonomy code 208800000X

Legal business name

EASTSIDE UROLOGY

Practice address

2121 Fountain Dr
Suite D
Snellville, GA 30078-7023

Phone

(770) 736-8368

Fax

(770) 736-8410

NPI assigned

May 17, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Carolyn L Vickers

Title

Director of Billing

Phone

(770) 736-8368

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073720959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 FOUNTAIN DR",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300787023",
            "telephone_number": "770-736-8368",
            "fax_number": "770-736-8410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 FOUNTAIN DR",
            "address_2": "SUITE D",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300787023",
            "telephone_number": "770-736-8368",
            "fax_number": "770-736-8410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE UROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VICKERS",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR OF BILLING",
        "authorized_official_telephone_number": "770-736-8368"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eastside Orthocare LLC
• Eastside Pathology Associates PC
• Eastside Pathology PC
• Eastside Rheumatology & Internal Medicine
• Eastside Spine & Pain Center
• Eastside Vascular Medicine and Surgery, P.C.
• Diana C Echeverria, BCBA
• John Samuel Eddinger, DMIN
• Donna Edmond
• Raquel Edward, RBT

• Urology Physician in Snellville, GA
• Providers in Snellville, GA by specialty
• Urology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.