Provider Demographics
NPI:1447590963
Name:CONRAD H EASLEY MD PC
Entity Type:Organization
Organization Name:CONRAD H EASLEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAUDETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:EASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-226-6318
Mailing Address - Street 1:1501 BROADRICK DR
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3014
Mailing Address - Country:US
Mailing Address - Phone:706-226-6318
Mailing Address - Fax:706-278-6031
Practice Address - Street 1:1501 BROADRICK DR
Practice Address - Street 2:SUITE # 3
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3014
Practice Address - Country:US
Practice Address - Phone:706-226-6318
Practice Address - Fax:706-278-6031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty