Organization
EASTSIDE ALLIED HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KHAMIS WAJDI IBRAHIM D.C. (CLINIC DIRECTOR)
(770) 482-1114
Entity
Organization
Contact information
Practice address
3081 STONE MOUNTAIN ST, LITHONIA, GA 30058-4426
(770) 482-1114
(770) 484-1206
Mailing address
3081 STONE MOUNTAIN ST, LITHONIA, GA 30058-4426
(770) 482-1114
(770) 484-1206
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIR006698
GA
207R00000X
Internal Medicine Physician
021747
GA
208D00000X
General Practice Physician
018820
GA
Other
Enumeration date
03/29/2007
Last updated
09/11/2025
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