Provider Demographics
NPI:1184255077
Name:EADE, THOMAS GEOFFREY (RPSGT, CCSH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:GEOFFREY
Last Name:EADE
Suffix:
Gender:M
Credentials:RPSGT, CCSH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 PECAN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-8370
Mailing Address - Country:US
Mailing Address - Phone:601-606-8410
Mailing Address - Fax:
Practice Address - Street 1:511 BROOKMAN DR
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2326
Practice Address - Country:US
Practice Address - Phone:601-835-9270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic