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General NPI Number Information
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NPI Number | 1184255077
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Entity Type | Individual
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Provider Name | THOMAS GEOFFREY EADE RPSGT, CCSH
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Gender | Male
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Dates
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Enumeration Date | 01/29/2020
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Last Update Date | 01/29/2020
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Provider Practice Location Address
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Address Line | 511 BROOKMAN DR
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City | BROOKHAVEN
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State | MS
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Zip | 39601-2326
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Country | US
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Telephone | 601-835-9270
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Fax |
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Provider Business Mailing Address
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Address Line | 202 PECAN BLVD
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City | BRANDON
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State | MS
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Zip | 39042-8370
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Country | US
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Telephone | 601-606-8410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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