Provider Demographics
NPI:1396504312
Name:EASON, ELINOR RUTH (RDH)
Entity type:Individual
Prefix:
First Name:ELINOR
Middle Name:RUTH
Last Name:EASON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ELINOR
Other - Middle Name:RUTH
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:730 MILE BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-9563
Mailing Address - Country:US
Mailing Address - Phone:404-539-1132
Mailing Address - Fax:
Practice Address - Street 1:3525 BUSBEE DR NW STE 200
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5677
Practice Address - Country:US
Practice Address - Phone:678-836-2115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH043399124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist