Healthcare Provider Details

I. General information

NPI: 1194334409
Provider Name (Legal Business Name): EVELYN AVILES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5163 THOMPSON BRIDGE RD
MURRAYVILLE GA
30564-1930
US

IV. Provider business mailing address

5163 THOMPSON BRIDGE RD
MURRAYVILLE GA
30564-1930
US

V. Phone/Fax

Practice location:
  • Phone: 470-354-3460
  • Fax:
Mailing address:
  • Phone: 470-354-3460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN248435
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: