Doctor Name: | JESSE BLAIR EASON |
NPI Number: | 1659666063 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 6090 |
Business Practice Address: | 3919 Main St Folkston, GA - 315377545 |
Business Phone Number: | 9124963426 |
Business Fax Number: | |
Mailing Address: | 218 Quarterman St, WAYCROSS |
State: | GA |
Postal Code: | 315013547 |
Phone Number: | 9122879140 |
Fax Number: | 9122871059 |
NPI Enumeration Date: | 06/14/2011 |
NPI Last Update Date: | 12/19/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 6090 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |