Provider Demographics
NPI:1134172521
Name:EBERHEART, FRANK ANDREW (PA-C)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:ANDREW
Last Name:EBERHEART
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14039
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30919-0039
Mailing Address - Country:US
Mailing Address - Phone:706-863-9797
Mailing Address - Fax:706-860-7686
Practice Address - Street 1:3650 J DEWEY GRAY CIR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1867
Practice Address - Country:US
Practice Address - Phone:706-863-9797
Practice Address - Fax:706-860-7686
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004672363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA643621982AMedicaid
GAME1331367OtherDEA
GA643621982AMedicaid
GAME1331367OtherDEA