Healthcare Provider Details

I. General information

NPI: 1144371618
Provider Name (Legal Business Name): JOAN D. EVANS, D.P.M., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 WOOD ST
TROY NC
27371-2849
US

IV. Provider business mailing address

433 WOOD ST
TROY NC
27371-2849
US

V. Phone/Fax

Practice location:
  • Phone: 910-576-2212
  • Fax: 910-576-2212
Mailing address:
  • Phone: 910-576-2212
  • Fax: 910-576-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number264
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number264
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number264
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number264
License Number StateNC

VIII. Authorized Official

Name: DR. JOAN D. EVANS
Title or Position: PRESIDENT
Credential: DPM
Phone: 910-576-2212