Healthcare Provider Details

I. General information

NPI: 1881506657
Provider Name (Legal Business Name): EVORA MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 E PACES FERRY RD NE
ATLANTA GA
30305-2351
US

IV. Provider business mailing address

365 E PACES FERRY RD NE
ATLANTA GA
30305-2351
US

V. Phone/Fax

Practice location:
  • Phone: 540-322-7542
  • Fax:
Mailing address:
  • Phone: 540-322-7542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DEJA MCCOY
Title or Position: OWNER
Credential:
Phone: 678-882-9111