Healthcare Provider Details

I. General information

NPI: 1346485000
Provider Name (Legal Business Name): ASHLEY CLACK EASON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 01/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5243 RIVERSIDE DR
MACON GA
31210-8803
US

IV. Provider business mailing address

4750 WATERS AVE STE 103
SAVANNAH GA
31404-6267
US

V. Phone/Fax

Practice location:
  • Phone: 229-365-3657
  • Fax:
Mailing address:
  • Phone: 912-350-5646
  • Fax: 912-350-5697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number078992
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number078992
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: