Provider Demographics
NPI:1619983483
Name:EASTERLIN, WRIGHT ABBOT (PA)
Entity Type:Individual
Prefix:MR
First Name:WRIGHT
Middle Name:ABBOT
Last Name:EASTERLIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WADLEY
Mailing Address - State:GA
Mailing Address - Zip Code:30477-4951
Mailing Address - Country:US
Mailing Address - Phone:478-625-7000
Mailing Address - Fax:478-625-8907
Practice Address - Street 1:152 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:WADLEY
Practice Address - State:GA
Practice Address - Zip Code:30477
Practice Address - Country:US
Practice Address - Phone:478-625-7000
Practice Address - Fax:478-625-8907
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002747363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100000172AMedicaid
GA97BBCGFMedicare Oscar/Certification