Organization
EASTSIDE UROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN L VICKERS (DIRECTOR OF BILLING)
(770) 736-8368
Entity
Organization
Contact information
Practice address
2121 FOUNTAIN DR, SUITE D, SNELLVILLE, GA 30078-7023
(770) 736-8368
(770) 736-8410
Mailing address
2121 FOUNTAIN DR, SNELLVILLE, GA 30078-7023
(770) 736-8368
(770) 736-8410
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Enumeration date
05/17/2007
Last updated
08/22/2020
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