# EASTSIDE INTERNAL MEDICINE, LLC

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

## Provider details

- **NPI number:** 1932256526
- **Authorized official:** HENRIETTA MADDOX (OFFICE MANAGER)
- **Authorized official phone:** (678) 625-7800

## Contact information

- **Practice address:** 2080 EASTSIDE DR, SUITE A, CONYERS, GA 30013-1953
- **Practice address phone:** (678) 625-7800
- **Practice address fax:** (678) 625-7888
- **Mailing address:** 2080 EASTSIDE DR, SUITE A, CONYERS, GA 30013-1953
- **Mailing address phone:** (678) 625-7800
- **Mailing address fax:** (678) 625-7888

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 173000000X | Legal Medicine | — | GA | Yes |

## Other

- **Enumeration date:** 01/04/2007
- **Last updated:** 07/21/2022