Healthcare Provider Details

I. General information

NPI: 1073788816
Provider Name (Legal Business Name): GREGORY E EVANS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 EAGLES LANDING PKWY
STOCKBRIDGE GA
30281-5085
US

IV. Provider business mailing address

950 EAGLES LANDING PKWY 116
STOCKBRIDGE GA
30281-7343
US

V. Phone/Fax

Practice location:
  • Phone: 313-587-3369
  • Fax:
Mailing address:
  • Phone: 313-587-3369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number70098
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number70098
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: