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General NPI Number Information
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NPI Number | 1144373051
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Entity Type | Individual
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Provider Name | NATHAN BRADLEY EASTERLIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 2500 STARLING ST SUITE 603
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City | BRUNSWICK
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State | GA
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Zip | 31520-4265
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Country | US
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Telephone | 912-280-9977
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Fax | 912-280-9995
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Provider Business Mailing Address
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Address Line | 2500 STARLING ST SUITE 603
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City | BRUNSWICK
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State | GA
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Zip | 31520-4265
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Country | US
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Telephone | 912-280-9977
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Fax | 912-280-9995
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 62971
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License Number State | GA
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