Healthcare Provider Details

I. General information

NPI: 1629682521
Provider Name (Legal Business Name): CHELSEY LYNNE EVANGELISTE BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEY LYNNE GRIFFIN

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 BUNKER HILL RD
COLUMBUS GA
31907-6719
US

IV. Provider business mailing address

130 CORRIDOR RD UNIT 3292
PONTE VEDRA BEACH FL
32004-7833
US

V. Phone/Fax

Practice location:
  • Phone: 904-446-0953
  • Fax: 904-485-8829
Mailing address:
  • Phone: 904-446-0953
  • Fax: 904-485-8829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88367
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: