Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 10627 | GA |
Y | 213EG0000X | General Practice | 10627 | GA |
NPI | 1003856485 |
---|---|
Provider Name | Donald Richard Eakin |
First Address | Marietta, GA 30066-2429 |
Second Address | Marietta, GA 30066-2429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 08/07/2007 |