Healthcare Provider Details

I. General information

NPI: 1861475402
Provider Name (Legal Business Name): EMORY LEVON EASTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EMORY LEVON EASTIN M.D.

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1686 SKYLYN DR SUITE 101
SPARTANBURG SC
29307-1058
US

IV. Provider business mailing address

PO BOX 743070
ATLANTA GA
30374-3070
US

V. Phone/Fax

Practice location:
  • Phone: 864-585-3456
  • Fax: 864-585-3209
Mailing address:
  • Phone: 864-560-4304
  • Fax: 864-560-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberJ4095
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number04-50625
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number29390
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: