Provider Demographics
NPI:1124210273
Name:EADY, LONDON (NPC)
Entity Type:Individual
Prefix:MS
First Name:LONDON
Middle Name:
Last Name:EADY
Suffix:
Gender:F
Credentials:NPC
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 626
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31059-1900
Mailing Address - Country:US
Mailing Address - Phone:478-454-3805
Mailing Address - Fax:478-454-3975
Practice Address - Street 1:821 N COBB ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2343
Practice Address - Country:US
Practice Address - Phone:478-454-3805
Practice Address - Fax:478-454-3975
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1086736363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I508395Medicare PIN