Provider Demographics
NPI:1497010003
Name:EALEY, LASHAWN (CRNA)
Entity Type:Individual
Prefix:
First Name:LASHAWN
Middle Name:
Last Name:EALEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WATSON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KINSEY
Mailing Address - State:AL
Mailing Address - Zip Code:36303-7640
Mailing Address - Country:US
Mailing Address - Phone:205-369-9886
Mailing Address - Fax:
Practice Address - Street 1:405 ARROWHEAD BLVD
Practice Address - Street 2:C
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1254
Practice Address - Country:US
Practice Address - Phone:770-268-6000
Practice Address - Fax:770-268-2908
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN221887367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered