Wright Abbot Easterlin, PA
Individual provider Active NPI Physician Assistant · Wadley, GA
NPI 1619983483 · NPPES record last updated Sep 22, 2020
Key facts
- NPI
- 1619983483
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 002747 (GA)
- Practice address
- 152 North Main Street
Wadley, GA 30477 - Phone
- (478) 625-7000
- Fax
- (478) 625-8907
- NPI assigned
- Jul 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Wake Forest University School of Medicine, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Hospital Authority of Jefferson County and the City of Louisville
Practice addresses (Care Compare)
152 N Main St
Wadley, GA 30477-4951
Phone (478) 252-8900
Hospital & facility affiliations
- Jefferson Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110602000534 | GA | Practitioner - Physician Assistant | 1153508916 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002747 | GA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hospital Authority of Jefferson County and the City of Louisville | Current |
Accepting new patients | |
| Hospital Authority of Jefferson County and the City of Louisville | Past | Accepting new patients | |
| Hospital Authority of Jefferson County and the City of Louisville | Past | Accepting new patients | |
| Hospital Authority of Jefferson County and the City of Louisville | Past | Accepting new patients |
Locations
1067 Peachtree St
#104
Louisville, GA 30434
Phone (912) 625-7000
1067 Peachtree St
Louisville, GA 30434
Phone (478) 625-7000
400 Canterbury Dr
Wrens, GA 30833
Phone (478) 625-7000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 002747 | GA | Yes |
Addresses
Primary practice location
152 North Main Street
Wadley, GA 30477
Mailing address
152 N Main St
Wadley, GA 30477-4951
Phone (478) 625-7000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100000172A | Medicaid | GA |
Other providers in Wadley, GA
- Meria Alexander
- Comfort Creek Post Acute LLC
- Cooper Speech Services LLC
- CVW Management Inc.
- East Georgia Healthcare Center Inc
- Ashley McCoy Edenfield
- Brittany Elrod
- John W Farrior
- John David Gunn
- Hospital Authority of Jefferson County and the City of Louisville
All providers in Wadley, GA · Physician Assistant in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.