Provider Demographics
NPI:1053846592
Name:EASTSIDE ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:EASTSIDE ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KARIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-922-7000
Mailing Address - Street 1:1805 HONEY CREEK CMNS SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-5828
Mailing Address - Country:US
Mailing Address - Phone:404-509-1868
Mailing Address - Fax:
Practice Address - Street 1:1805 HONEY CREEK CMNS SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-5828
Practice Address - Country:US
Practice Address - Phone:404-509-1868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical