Healthcare Provider Details

I. General information

NPI: 1407395262
Provider Name (Legal Business Name): JASON LAMAR EVANS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 W PEACHTREE ST NW
ATLANTA GA
30308-1199
US

IV. Provider business mailing address

4009 VILLA LAKE RD
POWDER SPRINGS GA
30127-5052
US

V. Phone/Fax

Practice location:
  • Phone: 770-325-0636
  • Fax:
Mailing address:
  • Phone: 770-325-0636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0029504
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP328375
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22307
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: