Provider Demographics
NPI:1265170138
Name:EAFORD, KEVIN CORDALE (CPT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:CORDALE
Last Name:EAFORD
Suffix:
Gender:M
Credentials:CPT
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 1976
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1016
Mailing Address - Country:US
Mailing Address - Phone:229-308-6839
Mailing Address - Fax:866-598-3337
Practice Address - Street 1:164 N OLD RIVER RD
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:GA
Practice Address - Zip Code:39823-5337
Practice Address - Country:US
Practice Address - Phone:229-308-6839
Practice Address - Fax:866-598-3337
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-21
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAM5N8Z5B6246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy