Healthcare Provider Details

I. General information

NPI: 1952510265
Provider Name (Legal Business Name): EVERGREEN WOMENS HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1998 HENDERSONVILLE RD SUITE 31
ASHEVILLE NC
28803-2349
US

IV. Provider business mailing address

1998 HENDERSONVILLE RD SUITE 31
ASHEVILLE NC
28803-2349
US

V. Phone/Fax

Practice location:
  • Phone: 828-687-6294
  • Fax: 828-687-6277
Mailing address:
  • Phone: 828-687-6294
  • Fax: 828-687-6277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number33034
License Number StateNC

VIII. Authorized Official

Name: DR. BENJAMIN B FANN
Title or Position: OWNER
Credential: MD
Phone: 828-687-6294