Provider Demographics
NPI:1467014977
Name:EASTERLING, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:EASTERLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 DERBY DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-3306
Mailing Address - Country:US
Mailing Address - Phone:803-463-1766
Mailing Address - Fax:
Practice Address - Street 1:179 DERBY DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-3306
Practice Address - Country:US
Practice Address - Phone:803-463-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide