Healthcare Provider Details

I. General information

NPI: 1124210273
Provider Name (Legal Business Name): LONDON EADY NPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 N COBB ST SUITE 100
MILLEDGEVILLE GA
31061-2343
US

IV. Provider business mailing address

PO BOX 626
MILLEDGEVILLE GA
31059-1900
US

V. Phone/Fax

Practice location:
  • Phone: 478-454-3805
  • Fax: 478-454-3975
Mailing address:
  • Phone: 478-454-3805
  • Fax: 478-454-3975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1086736
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: