Provider Demographics
NPI:1972384477
Name:EAST, CARL WAYNE III (PA-C)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:WAYNE
Last Name:EAST
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:411 QUAIL HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-1029
Mailing Address - Country:US
Mailing Address - Phone:434-941-8142
Mailing Address - Fax:
Practice Address - Street 1:2542 LANGHORNE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1602
Practice Address - Country:US
Practice Address - Phone:434-200-5297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110009765363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant