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General NPI Number Information
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NPI Number | 1811184245
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Entity Type | Organization
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Legal Business Name | EASTSIDE ENDOCRINE, PC
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 1600 MEDICAL WAY SUITE200
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City | SNELLVILLE
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State | GA
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Zip | 30078
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Country | US
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Telephone | 770-979-7466
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Fax | 770-979-7455
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Provider Business Mailing Address
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Address Line | 1600 MEDICAL WAY SUITE 200
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City | SNELLVILLE
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State | GA
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Zip | 30078
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Country | US
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Telephone | 770-979-7466
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Fax | 770-979-7455
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Authorized Official
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Title or Position | PRESIDENT
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Name | NALAND P. SHENOY
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Credential | MD
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Telephone | 770-979-7466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 053165
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License Number State | GA
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