Provider Demographics
NPI:1588631089
Name:EATON, DAVID ERIC (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ERIC
Last Name:EATON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7494 EULIE WOOD DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-1144
Mailing Address - Country:US
Mailing Address - Phone:229-247-9124
Mailing Address - Fax:
Practice Address - Street 1:23RD MEDICAL GROUP (ACC)
Practice Address - Street 2:
Practice Address - City:MOODY AFB
Practice Address - State:GA
Practice Address - Zip Code:31605-4406
Practice Address - Country:US
Practice Address - Phone:520-228-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1032904363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant