Provider Demographics
NPI:1831999119
Name:EAKIN, COLE SAMUEL (MATRN, ATC)
Entity type:Individual
Prefix:
First Name:COLE
Middle Name:SAMUEL
Last Name:EAKIN
Suffix:
Gender:
Credentials:MATRN, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 BRIARWOOD RD # 130
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-2459
Mailing Address - Country:US
Mailing Address - Phone:503-333-6734
Mailing Address - Fax:
Practice Address - Street 1:1332 SOUTHERN DR
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30460-1360
Practice Address - Country:US
Practice Address - Phone:912-478-4636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPENDING2255A2300X
FLAL70222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer