Individual
JESSE BLAIR EASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2501 N PATTERSON ST, VALDOSTA, GA 31602-1735
(229) 333-1110
Mailing address
4904 PRINCESS DR, LAKE PARK, GA 31636-3120
(229) 630-8658
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
6090
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003111610A
—
GA
Enumeration date
06/14/2011
Last updated
01/10/2018
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