Healthcare Provider Details

I. General information

NPI: 1992623425
Provider Name (Legal Business Name): ANA GRACE EVANS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N CRAWFORD ST
THOMASVILLE GA
31792-5125
US

IV. Provider business mailing address

326 BRIARCLIFF DR
THOMASVILLE GA
31792-3933
US

V. Phone/Fax

Practice location:
  • Phone: 229-236-0260
  • Fax: 229-236-0263
Mailing address:
  • Phone: 229-516-0262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP014242
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: