# EASTSIDE ALLIED HEALTH, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568582179
- **Authorized official:** DR. KHAMIS WAJDI IBRAHIM D.C. (CLINIC DIRECTOR)
- **Authorized official phone:** (770) 482-1114

## Contact information

- **Practice address:** 3081 STONE MOUNTAIN ST, LITHONIA, GA 30058-4426
- **Practice address phone:** (770) 482-1114
- **Practice address fax:** (770) 484-1206
- **Mailing address:** 3081 STONE MOUNTAIN ST, LITHONIA, GA 30058-4426
- **Mailing address phone:** (770) 482-1114
- **Mailing address fax:** (770) 484-1206

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | CHIR006698 | GA | Yes |
| 207R00000X | Internal Medicine Physician | 021747 | GA | — |
| 208D00000X | General Practice Physician | 018820 | GA | — |

## Other

- **Enumeration date:** 03/29/2007
- **Last updated:** 09/11/2025