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NPI Code Detail

MEDICARE: JOHN EANES II MD

MEDICARE: JOHN EANES II MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician56433GA

General Provider Information

NPI Number : 1609866938
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN EANES II MD
Provider Business Mailing Address
First Line : 1001 JOHNSON FY RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30342-1605
Country : US
Telephone Number : 404-785-4826
Fax Number : 404-785-4820
Provider Business Practice Location Address
First Line : 1577 NORTHEAST EXPY NE
Second Line :
City : BROOKHAVEN
State : GA
Zip : 30329-2401
Country : US
Telephone Number : 404-785-0976
Fax Number : 404-785-5845
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2005
Last Update Date : 04/23/2025

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