Individual
JEFFREY CHARLES EASOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3051 WATSON BLVD, SUITE 400, WARNER ROBINS, GA 31093-8536
(478) 953-4563
(478) 953-4616
Mailing address
3051 WATSON BLVD, SUITE 400, WARNER ROBINS, GA 31093-8536
(478) 953-4563
(478) 953-4683
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
054269
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
976624642A
—
GA
Enumeration date
04/26/2006
Last updated
10/26/2012
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