OrganizationActive
Eastside Internal Medicine, LLC
NPI 1932256526 · Legal Medicine · Conyers, GA
Provider details
- NPI number
- 1932256526
- Entity type
- Organization
- Primary specialty
- Legal MedicineOther Service Providers
- Organization subpart
- No
- Authorized official
- Henrietta Maddox, Office Manager(678) 625-7800
Specialties & taxonomies
Other Service Providers
Practice location
2080 Eastside Dr
Suite a
Conyers, GA 30013-1953
Phone: (678) 625-7800
Fax: (678) 625-7888
Approximate (ZIP-level) locationGet directions
Mailing address
2080 Eastside Dr
Conyers, GA 30013-1953
Registry dates
- Enumerated
- 2007-01-04
- Last updated
- 2022-07-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.