Healthcare Provider Details

I. General information

NPI: 1821670258
Provider Name (Legal Business Name): EVOLVE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 04/26/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3631 CHAMBLEE TUCKER RD SUITE A #288
ATLANTA GA
30341
US

IV. Provider business mailing address

3631 CHAMBLEE TUCKER RD SUITE A #288
ATLANTA GA
30341
US

V. Phone/Fax

Practice location:
  • Phone: 404-491-7716
  • Fax: 404-393-3441
Mailing address:
  • Phone: 404-491-7716
  • Fax: 404-393-3441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JASMIN BOOKER
Title or Position: CHEIF OPERATING OFFICER
Credential:
Phone: 404-491-7716