Provider Demographics
NPI:1295122109
Name:EANES, ALISA KATHERINE (MD)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:KATHERINE
Last Name:EANES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 SUGAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-5239
Mailing Address - Country:US
Mailing Address - Phone:828-659-3621
Mailing Address - Fax:
Practice Address - Street 1:1633 SUGAR HILL RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-5239
Practice Address - Country:US
Practice Address - Phone:828-659-3621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-01136207VX0000X, 207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2017-01136OtherMEDICAL LICENSE
NCNN735AOtherMAHEC MEDICARE PTAN