Provider Demographics
NPI:1285701987
Name:EASON, JOHN HENRY JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HENRY
Last Name:EASON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 MEDICAL PARK DRIVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5782
Mailing Address - Country:US
Mailing Address - Phone:865-988-4452
Mailing Address - Fax:865-988-6293
Practice Address - Street 1:460 MEDICAL PARK DR STE 106
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5782
Practice Address - Country:US
Practice Address - Phone:865-988-4452
Practice Address - Fax:865-988-6293
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000021520208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100010807OtherPHP TENNCARE
TN62-1762205OtherGROUP TAX ID
1740052OtherUNITED HEALTH CARE
TN3061848Medicaid
TN3081453OtherBLUE CARE
1962443069OtherNPI NO FOR GROUP ONLY DOC
TN3081453OtherBLUE CROSS BLUE SHIELD OF
TN020049205OtherMEDICARE RAILROAD
282829OtherONE HEALTH
4359544002OtherCIGNA
TN100010807OtherPHP TENNCARE
TN62-1762205OtherGROUP TAX ID
TN3061848Medicaid