Provider Demographics
NPI:1629670047
Name:AUSTIN, ERIC DAWAYNE SR
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DAWAYNE
Last Name:AUSTIN
Suffix:SR
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 1:420 NAPA VALLEY DR APT 2202
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-5099
Mailing Address - Country:US
Mailing Address - Phone:501-563-5984
Mailing Address - Fax:
Practice Address - Street 1:420 NAPA VALLEY DR APT 2202
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-5099
Practice Address - Country:US
Practice Address - Phone:501-563-5984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program