Healthcare Provider Details

I. General information

NPI: 1659063576
Provider Name (Legal Business Name): EVELYN C WEST SPECIALIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 POWDER SPRINGS RD SW
MARIETTA GA
30064-4567
US

IV. Provider business mailing address

2665 FAVOR RD SW # 2I02
MARIETTA GA
30060-5237
US

V. Phone/Fax

Practice location:
  • Phone: 513-882-2607
  • Fax:
Mailing address:
  • Phone: 513-882-2607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: