Provider Demographics
NPI:1720077282
Name:EASLEY OB GYN ASSOCIATES PA
Entity type:Organization
Organization Name:EASLEY OB GYN ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MOVIUS
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-855-2737
Mailing Address - Street 1:112 JOHN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-1472
Mailing Address - Country:US
Mailing Address - Phone:864-855-2737
Mailing Address - Fax:864-855-2221
Practice Address - Street 1:112 JOHN STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-1207
Practice Address - Country:US
Practice Address - Phone:864-855-2737
Practice Address - Fax:864-855-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8415207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC084152Medicaid
D90811Medicare UPIN