Healthcare Provider Details

I. General information

NPI: 1104890532
Provider Name (Legal Business Name): KEVIN EVERETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MEDICAL CENTER BLVD
LAWRENCEVILLE GA
30046-7694
US

IV. Provider business mailing address

361 VILLAGE CREEK DR
JASPER GA
30143-8730
US

V. Phone/Fax

Practice location:
  • Phone: 678-312-1000
  • Fax: 678-312-3282
Mailing address:
  • Phone: 251-421-6197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME160201
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number73531
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number319551
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number18720
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: