Healthcare Provider Details

I. General information

NPI: 1588660948
Provider Name (Legal Business Name): GUY T EASTERLING DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 PERRY HWY
HAWKINSVILLE GA
31036-6748
US

IV. Provider business mailing address

PO BOX 1297
HAWKINSVILLE GA
31036-7297
US

V. Phone/Fax

Practice location:
  • Phone: 478-892-9670
  • Fax: 478-892-9678
Mailing address:
  • Phone: 478-892-9670
  • Fax: 478-892-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number041283
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: