NPIMap

Organization Active NPI

Eastside Internal Medicine, LLC

  • Internal Medicine Physician
  • Conyers, GA
National Provider Identifier
1437211703
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
EASTSIDE INTERNAL MEDICINE, LLC
Practice address
2080 Eastside Dr
Suite a
Conyers, GA 30013-1953
Phone
(678) 625-7800
Fax
(678) 625-7888
NPI assigned
Dec 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Syed Wasim, M.D.NPI 1992763809
Title
Owner
Phone
(678) 625-7800

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 Primary

Addresses

Primary practice location

2080 Eastside Dr
Suite a
Conyers, GA 30013-1953

Mailing address

2080 Eastside Dr
Suite a
Conyers, GA 30013-1953
Phone (678) 625-7800

Other identifiers 3

IdentifierTypeStateIssuer
1093773905OtherGANPI NUMBER
1992763809OtherGANPI NUMBER
1871551788OtherGANPI NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Eastside Internal Medicine2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437211703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2080 EASTSIDE DR",
            "address_2": "SUITE A",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300131953",
            "telephone_number": "678-625-7800",
            "fax_number": "678-625-7888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 EASTSIDE DR",
            "address_2": "SUITE A",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300131953",
            "telephone_number": "678-625-7800",
            "fax_number": "678-625-7888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE INTERNAL MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WASIM",
        "authorized_official_first_name": "SYED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-625-7800",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER",
            "identifier": "1093773905",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER",
            "identifier": "1992763809",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER",
            "identifier": "1871551788",
            "state": "GA"
        }
    ],
    "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 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.