Eastside Internal Medicine, LLC

Primary specialty

Legal MedicineTaxonomy code 173000000X

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

Jan 4, 2007

Last updated

Jul 21, 2022By 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

Henrietta Maddox

Title

Office Manager

Phone

(678) 625-7800

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

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.

• Eastside Internal Medicine, LLC

  • Internal Medicine Physician
  • Conyers, GA
  • NPI 1437211703
  NPD tax ID

Locations

Practitioners 3

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.

• Farhana Quasem, MD

  • Internal Medicine Physician
  • Conyers, GA
  • NPI 1093773905
  Medicare reassignment Care Compare group NPD
• Masood Siddiquee, MD

  • Internal Medicine Physician
  • Conyers, GA
  • NPI 1871551788
  Medicare reassignment Care Compare group NPD
• Syed Wasim, MD

  • Internal Medicine Physician
  • Conyers, GA
  • NPI 1992763809
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1932256526",
    "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": "2007-01-04",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MADDOX",
        "authorized_official_first_name": "HENRIETTA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "678-625-7800"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eastmetro Eyecare P.C.
• Eastside Endoscopy Center LLC
• Eastside Endoscopy Center, LLC
• Eastside Endoscopy Center, LLC
• Eastside Internal Medicine, LLC
• Eastside Premier Nephrology & Hypertension PC
• Easy Go Mobile Lab Service LLC
• Easymed EMS LLC
• Chelsea N Ector, ATC
• Neil Edgerton, M.D.

• Legal Medicine in Conyers, GA
• Providers in Conyers, GA by specialty
• Legal Medicine in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.