Provider Demographics
NPI:1033270624
Name:EASON, WILLIAM CLAUDE (CO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CLAUDE
Last Name:EASON
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 564
Mailing Address - Street 2:
Mailing Address - City:HARDWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31034-0564
Mailing Address - Country:US
Mailing Address - Phone:478-453-7327
Mailing Address - Fax:478-451-0741
Practice Address - Street 1:535 N COBB ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2636
Practice Address - Country:US
Practice Address - Phone:478-453-7327
Practice Address - Fax:478-451-0741
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0321370001Medicare NSC