Provider Demographics
NPI:1205165214
Name:GEORGE WILLIAM EASON MD
Entity type:Organization
Organization Name:GEORGE WILLIAM EASON MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:EASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-200-1438
Mailing Address - Street 1:1312 AIRLIE RD
Mailing Address - Street 2:UNIT 2
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3727
Mailing Address - Country:US
Mailing Address - Phone:910-200-1438
Mailing Address - Fax:866-272-0858
Practice Address - Street 1:1312 AIRLIE RD
Practice Address - Street 2:UNIT 2
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3727
Practice Address - Country:US
Practice Address - Phone:910-200-1438
Practice Address - Fax:866-272-0858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty