Provider Demographics
NPI:1629191663
Name:FAN, ERIC C (DO)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:C
Last Name:FAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:103 LAUREL OAK LN
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-7647
Mailing Address - Country:US
Mailing Address - Phone:850-766-6566
Mailing Address - Fax:229-233-0927
Practice Address - Street 1:601 11TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1645
Practice Address - Country:US
Practice Address - Phone:850-766-6566
Practice Address - Fax:229-233-0927
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA496152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
26BDHLHMedicare PIN
F30101Medicare UPIN