Basic Information
| Provider Information | |||||||||
| NPI: | 1003008111 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EASTERLIN | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | OWSLEY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 418 EH CT | ||||||||
| Address2: | UNIT 4B | ||||||||
| City: | BRUNSWICK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315202199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9122670884 | ||||||||
| FaxNumber: | 9132679396 | ||||||||
| Practice Location | |||||||||
| Address1: | 418 EH CT | ||||||||
| Address2: | UNIT 4B | ||||||||
| City: | BRUNSWICK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315202199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9122670884 | ||||||||
| FaxNumber: | 9132679396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2007 | ||||||||
| LastUpdateDate: | 10/02/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 1536 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 253182 | NY | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 003113870A | 05 | GA | MEDICAID |