Provider Demographics
NPI:1174788970
Name:EASON, AUDRA WOODRUFF (MD)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:WOODRUFF
Last Name:EASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:KINCHEN
Other - Last Name:WOODRUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:860 MONTCLAIR RD
Mailing Address - Street 2:SUITE 955
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1923
Mailing Address - Country:US
Mailing Address - Phone:205-332-3160
Mailing Address - Fax:866-702-0880
Practice Address - Street 1:860 MONTCLAIR RD
Practice Address - Street 2:SUITE 955
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1923
Practice Address - Country:US
Practice Address - Phone:205-332-3160
Practice Address - Fax:866-702-0880
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL324422081P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine