Eastlyn E Harding-Marin, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

55689 Issued in GA

Practice address

211 Fairview Rd
Ellenwood, GA 30294-2721

Phone

(770) 507-4554

Fax

(770) 507-6413

NPI assigned

May 31, 2006

Last updated

Apr 9, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Family Practice & Urgent Care

  • Health Service Clinic/Center
  • Covington, GA
  • NPI 1568625457
  Medicare reassignment NPD Authorized official
• Aylo Health, LLC

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1013018811
  NPD (past)
• Aylo Health, LLC

  • Family Medicine Physician
  • Locust Grove, GA
  • NPI 1710929914
  NPD (past)
• Aylo Health, LLC

  • Sleep Medicine (Family Medicine) Physician
  • Stockbridge, GA
  • NPI 1922831445
  NPD (past)
• Montefiore Medical Center

  • Anesthesiology Physician
  • Bronx, NY
  • NPI 1063525152
  NPD (past)
• South Beach Medical PC

  • Internal Medicine Physician
  • Far Rockaway, NY
  • NPI 1699872499
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207699200000",
    "number": "1912944083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 FAIRVIEW RD",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302942721",
            "telephone_number": "770-507-4554",
            "fax_number": "770-507-6413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 FAIRVIEW RD",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302942721",
            "telephone_number": "770-507-4554",
            "fax_number": "770-507-6413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDING-MARIN",
        "first_name": "EASTLYN",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-31",
        "last_updated": "2008-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "55689",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00319023",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Saurabh Gulati, M.D.
• Mykeela Hackett
• David M. Hall, DC
• Shannon Lacerne Hall
• Ashley Nicole Hand
• Cheryl Delores Harrell Brinkley, PSY.D
• Angela Harris
• Santrell Denise Hart-Moreland, O.D.,M.P.H.
• Harvestlodge Homes and Services for Children and Families
• Kamica Ross Hatchett, CRNA

• Family Medicine Physician in Ellenwood, GA
• Providers in Ellenwood, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.