Healthcare Provider Details

I. General information

NPI: 1063800548
Provider Name (Legal Business Name): AMY EVANS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 MACLAND RD
DALLAS GA
30132-5052
US

IV. Provider business mailing address

105 VILLAGE WALK STE 280
DALLAS GA
30132-5506
US

V. Phone/Fax

Practice location:
  • Phone: 770-441-4001
  • Fax:
Mailing address:
  • Phone: 770-800-6780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN183099
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: