Basic Information
| Provider Information | |||||||||
| NPI: | 1184255077 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EADE | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | GEOFFREY | ||||||||
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| Credential: | RPSGT, CCSH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 PECAN BLVD | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390428370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016068410 | ||||||||
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| Practice Location | |||||||||
| Address1: | 511 BROOKMAN DR | ||||||||
| Address2: | |||||||||
| City: | BROOKHAVEN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396012326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018359270 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2020 | ||||||||
| LastUpdateDate: | 01/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.