Healthcare Provider Details

I. General information

NPI: 1598338600
Provider Name (Legal Business Name): RODNEY L EVANS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HARTSFIELD CENTER PKWY STE 522
ATLANTA GA
30354-1341
US

IV. Provider business mailing address

100 HARTSFIELD CENTER PKWY STE 522
ATLANTA GA
30354-1341
US

V. Phone/Fax

Practice location:
  • Phone: 404-308-3176
  • Fax: 877-487-9774
Mailing address:
  • Phone: 404-308-3176
  • Fax: 877-487-9774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number11763842
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: