Individual
DR. MARY JEAN EAST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
539 HARDEE ST, DALLAS, GA 30132-4711
(770) 505-0531
(770) 485-0570
Mailing address
539 HARDEE ST, DALLAS, GA 30132-4711
(770) 505-0531
(770) 485-0570
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
063187
GA
363LF0000X
Family Nurse Practitioner
RN032537
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000430515A
—
GA
05
—
085000588G
—
GA
Enumeration date
04/10/2006
Last updated
08/08/2012
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