Basic Information
| Provider Information | |||||||||
| NPI: | 1588631089 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EATON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ERIC | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7494 EULIE WOOD DR | ||||||||
| Address2: | |||||||||
| City: | VALDOSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 316011144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292479124 | ||||||||
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| Practice Location | |||||||||
| Address1: | 23RD MEDICAL GROUP (ACC) | ||||||||
| Address2: | |||||||||
| City: | MOODY AFB | ||||||||
| State: | GA | ||||||||
| PostalCode: | 316054406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202282511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2006 | ||||||||
| LastUpdateDate: | 10/03/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1032904 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.