Healthcare Provider Details

I. General information

NPI: 1801527502
Provider Name (Legal Business Name): DANAH MARTRECE EVANS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

480 CATTAIL IVES RD
LAWRENCEVILLE GA
30045-8102
US

V. Phone/Fax

Practice location:
  • Phone: 478-464-8134
  • Fax:
Mailing address:
  • Phone: 678-642-8469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN177988
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberRN177988
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: