Provider Demographics
NPI:1003415803
Name:ESHLEMAN, CARLEY E
Entity Type:Individual
Prefix:
First Name:CARLEY
Middle Name:E
Last Name:ESHLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 MCCALL WAY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-5600
Mailing Address - Country:US
Mailing Address - Phone:770-905-5423
Mailing Address - Fax:
Practice Address - Street 1:4220 GAUNTT RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-0600
Practice Address - Country:US
Practice Address - Phone:762-499-2925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT014809OtherPROFESSIONAL LICENSE