Healthcare Provider Details

I. General information

NPI: 1144373051
Provider Name (Legal Business Name): NATHAN BRADLEY EASTERLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 STARLING ST SUITE 603
BRUNSWICK GA
31520-4265
US

IV. Provider business mailing address

2500 STARLING ST SUITE 603
BRUNSWICK GA
31520-4265
US

V. Phone/Fax

Practice location:
  • Phone: 912-280-9977
  • Fax: 912-280-9995
Mailing address:
  • Phone: 912-280-9977
  • Fax: 912-280-9995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number62971
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: