Basic Information
Provider Information
NPI: 1003008111
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EASTERLIN
FirstName: MARIE
MiddleName: OWSLEY
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X253182NYN Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 
207V00000X1536GAY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

ID Information
IDTypeStateIssuerDescription
003113870A05GA MEDICAID


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