Healthcare Provider Details

I. General information

NPI: 1740138585
Provider Name (Legal Business Name): EVAN SEAGRAVES PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GREEN ST NW STE 100D
GAINESVILLE GA
30501-3361
US

IV. Provider business mailing address

16 CREEK CT
TOCCOA GA
30577-6189
US

V. Phone/Fax

Practice location:
  • Phone: 470-306-0096
  • Fax:
Mailing address:
  • Phone: 706-248-4828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP295274
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: