Basic Information
Provider Information | |||||||||
NPI: | 1821025867 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | EASON | ||||||||
FirstName: | WILLIAM | ||||||||
MiddleName: | ANDREW | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 270 E COURT AVE | ||||||||
Address2: |   | ||||||||
City: | SELMER | ||||||||
State: | TN | ||||||||
PostalCode: | 383752304 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7316457932 | ||||||||
FaxNumber: | 7316455195 | ||||||||
Practice Location | |||||||||
Address1: | 270 E COURT AVE | ||||||||
Address2: |   | ||||||||
City: | SELMER | ||||||||
State: | TN | ||||||||
PostalCode: | 383752304 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7316457932 | ||||||||
FaxNumber: | 7316455195 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/26/2006 | ||||||||
LastUpdateDate: | 07/14/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20944 | TN | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 115569 | 05 | TN |   | MEDICAID | 3124134 | 01 | TN | BLUE CROSS BLUE SHIELD A | OTHER | 12096 | 05 | TN |   | MEDICAID | 3124135 | 01 | TN | BLUE CROSS BLUE SHIELD H | OTHER | 3123018 | 01 | TN | BLUE CROSS BLUE SHIELD S | OTHER | 3717101 | 05 | TN |   | MEDICAID |