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General NPI Number Information
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NPI Number | 1447590963
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Entity Type | Organization
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Legal Business Name | CONRAD H EASLEY MD PC
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Dates
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Enumeration Date | 02/20/2013
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Last Update Date | 02/20/2013
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Provider Practice Location Address
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Address Line | 1501 BROADRICK DR SUITE # 3
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City | DALTON
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State | GA
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Zip | 30720-3014
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Country | US
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Telephone | 706-226-6318
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Fax | 706-278-6031
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Provider Business Mailing Address
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Address Line | 1501 BROADRICK DR SUITE # 3
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City | DALTON
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State | GA
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Zip | 30720-3014
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Country | US
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Telephone | 706-226-6318
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Fax | 706-278-6031
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Authorized Official
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Title or Position | SECRETARY
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Name | MRS. CLAUDETTE EASLEY
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Credential |
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Telephone | 706-226-6318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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