Provider Demographics
NPI:1326597857
Name:EATMON, ISAIAH CARY (AA BUSINESS MANAGEME)
Entity Type:Individual
Prefix:
First Name:ISAIAH
Middle Name:CARY
Last Name:EATMON
Suffix:
Gender:M
Credentials:AA BUSINESS MANAGEME
Other - Prefix:
Other - First Name:ISAIAH
Other - Middle Name:CARY
Other - Last Name:EATMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AA MANAGEMENT
Mailing Address - Street 1:301 W MONTANA ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-5216
Mailing Address - Country:US
Mailing Address - Phone:313-867-3284
Mailing Address - Fax:313-867-3284
Practice Address - Street 1:301 W MONTANA ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-5216
Practice Address - Country:US
Practice Address - Phone:313-867-3284
Practice Address - Fax:313-867-3284
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator