Eastside Bariatric & General Surgery LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

068948 Issued in GA

Legal business name

EASTSIDE BARIATRIC & GENERAL SURGERY LLC

Practice address

1800 Tree LN Ste 330
Snellville, GA 30078-4700

Phone

(678) 585-4657

NPI assigned

May 31, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Aliu Sanni, M.D.NPI 1629226758

Title

Owner

Phone

(678) 585-4657

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 2

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

• Aliu O Sanni, MD

  • Specialist
  • Loganville, GA
  • NPI 1629226758

  GA

  Medicare reassignment Authorized official
• Tracy Kuzava, MBA, RDN, LD

  • Registered Dietitian
  • Snellville, GA
  • NPI 1740521848
  NPD

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

{
    "created_epoch": "1464652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464652800000",
    "number": "1922456045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 TREE LN STE 330",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300784700",
            "telephone_number": "678-585-4657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 TREE LN STE 330",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300784700",
            "telephone_number": "678-585-4657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE BARIATRIC & GENERAL SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-31",
        "last_updated": "2016-05-31",
        "status": "A",
        "authorized_official_last_name": "SANNI",
        "authorized_official_first_name": "ALIU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-585-4657",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "GA",
            "license": "068948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Snellville, GA
• Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.