Healthcare Provider Details

I. General information

NPI: 1144407750
Provider Name (Legal Business Name): EVANS IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 TOWNE CENTER DRIVE SUITE 1000
EVANS GA
30809
US

IV. Provider business mailing address

1125 TROUPE ST
AUGUSTA GA
30904-4480
US

V. Phone/Fax

Practice location:
  • Phone: 706-868-3940
  • Fax: 706-868-3979
Mailing address:
  • Phone: 706-737-4575
  • Fax: 706-731-5289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name: DR. STEVEN G. ROGERS
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 706-737-4575