Individual
EASTLYN E HARDING-MARIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
211 FAIRVIEW RD, ELLENWOOD, GA 30294-2721
(770) 507-4554
(770) 507-6413
Mailing address
211 FAIRVIEW RD, ELLENWOOD, GA 30294-2721
(770) 507-4554
(770) 507-6413
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
55689
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00319023
RAILROAD MEDICARE
GA
Enumeration date
05/31/2006
Last updated
04/09/2008
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