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General NPI Number Information
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NPI Number | 1922456045
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Entity Type | Organization
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Legal Business Name | EASTSIDE BARIATRIC & GENERAL SURGERY LLC
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 1800 TREE LN STE 330
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City | SNELLVILLE
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State | GA
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Zip | 30078-4700
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Country | US
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Telephone | 678-585-4657
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 TREE LN STE 330
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City | SNELLVILLE
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State | GA
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Zip | 30078-4700
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Country | US
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Telephone | 678-585-4657
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALIU SANNI
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Credential | M.D.
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Telephone | 678-585-4657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 068948
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License Number State | GA
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