Provider Demographics
NPI:1588660948
Name:EASTERLING, GUY T (DO)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:T
Last Name:EASTERLING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1297
Mailing Address - Street 2:
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-7297
Mailing Address - Country:US
Mailing Address - Phone:478-892-9670
Mailing Address - Fax:478-892-9678
Practice Address - Street 1:202 PERRY HWY
Practice Address - Street 2:
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-6748
Practice Address - Country:US
Practice Address - Phone:478-892-9670
Practice Address - Fax:478-892-9678
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041283207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000687816CMedicaid
GA000687816DMedicaid
F77899Medicare UPIN
11BDKNJMedicare PIN