Individual
MRS. DERRICK LEIGH EASOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2810 N OAK ST, VALDOSTA, GA 31602-1716
(229) 938-6495
Mailing address
2810 N OAK ST, VALDOSTA, GA 31602-1716
(229) 938-6495
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN248094
GA
Other
Enumeration date
09/18/2018
Last updated
02/05/2025
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