Healthcare Provider Details

I. General information

NPI: 1700935293
Provider Name (Legal Business Name): ANGELA R EVANS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 JOHNSON FY RD NE STE 110
ATLANTA GA
30342-1607
US

IV. Provider business mailing address

980 JOHNSON FY RD NE STE 110
ATLANTA GA
30342-1607
US

V. Phone/Fax

Practice location:
  • Phone: 404-303-7004
  • Fax: 404-303-7020
Mailing address:
  • Phone: 404-303-7004
  • Fax: 404-303-7020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number1568
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number137531
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number137531
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: