Provider Demographics
NPI:1386735066
Name:EAST METRO INTERNAL MEDICINE
Entity type:Organization
Organization Name:EAST METRO INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROOPAL
Authorized Official - Middle Name:ANIL
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-918-1234
Mailing Address - Street 1:3641 HIGHWAY 20 SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-3064
Mailing Address - Country:US
Mailing Address - Phone:770-918-1234
Mailing Address - Fax:770-918-1235
Practice Address - Street 1:3641 HIGHWAY 20 SE
Practice Address - Street 2:SUITE A
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-3064
Practice Address - Country:US
Practice Address - Phone:770-918-1234
Practice Address - Fax:770-918-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP6116Medicare ID - Type Unspecified