MEDICARE: DAVID ERIC EATON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1032904	GA

General Provider Information

NPI Number	:	1588631089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ERIC EATON PA-C

Provider Business Mailing Address
First Line	:	7494 EULIE WOOD DR
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31601-1144
Country	:	US
Telephone Number	:	229-247-9124
Fax Number	:

Provider Business Practice Location Address
First Line	:	23RD MEDICAL GROUP (ACC)
Second Line	:
City	:	MOODY AFB
State	:	GA
Zip	:	31605-4406
Country	:	US
Telephone Number	:	520-228-2511
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	10/03/2007

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