Provider Demographics
NPI:1093177883
Name:EASTSIDE URGENT CARE, LLC
Entity Type:Organization
Organization Name:EASTSIDE URGENT CARE, LLC
Other - Org Name:EASTSIDE URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVREET
Authorized Official - Middle Name:
Authorized Official - Last Name:PANNU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-895-9275
Mailing Address - Street 1:450 14TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-7963
Mailing Address - Country:US
Mailing Address - Phone:770-884-4399
Mailing Address - Fax:404-410-7707
Practice Address - Street 1:3370 SUGARLOAF PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-5478
Practice Address - Country:US
Practice Address - Phone:678-895-9275
Practice Address - Fax:404-410-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care