Healthcare Provider Details

I. General information

NPI: 1023204344
Provider Name (Legal Business Name): BARBARA EVANS CST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 PEACHTREE RD NE SUITE 705
ATLANTA GA
30309-1476
US

IV. Provider business mailing address

2001 PEACHTREE RD NE SUITE 705
ATLANTA GA
30309-1476
US

V. Phone/Fax

Practice location:
  • Phone: 404-355-0743
  • Fax: 404-425-1547
Mailing address:
  • Phone: 404-355-0743
  • Fax: 404-425-1547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number077160
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: