MEDICARE: DR. KELLY R EVERMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MD48847	TN
2	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	MD48847	TN
3	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	38136	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730181090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY R EVERMAN M.D.

Provider Business Mailing Address
First Line	:	1800 CHURCH ST
Second Line	:	SUITE 100
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2208
Country	:	US
Telephone Number	:	615-329-3624
Fax Number	:	615-329-0639

Provider Business Practice Location Address
First Line	:	1800 CHURCH ST
Second Line	:	SUITE 100
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2208
Country	:	US
Telephone Number	:	615-329-3624
Fax Number	:	615-329-0639

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	03/23/2017

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