Basic Information
| Provider Information | |||||||||
| NPI: | 1427396498 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EASTMAN SURGICAL ASSOCIATES, LLC | ||||||||
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| OtherOrganizationName: | EASTMAN SURGICAL ASSOCIATES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4128 | ||||||||
| Address2: | |||||||||
| City: | EASTMAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310234128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4784484000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 829 PLAZA AVE | ||||||||
| Address2: | |||||||||
| City: | EASTMAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310236757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4784484000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2013 | ||||||||
| LastUpdateDate: | 01/24/2013 | ||||||||
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| AuthorizedOfficialLastName: | HAMRICK | ||||||||
| AuthorizedOfficialFirstName: | JAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4784484000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.