Healthcare Provider Details

I. General information

NPI: 1255339131
Provider Name (Legal Business Name): THOMAS EDWIN EVANS M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11082 N RADIO STATION RD
SENECA SC
29678-1142
US

IV. Provider business mailing address

1 INDEPENDENCE PT SUITE 212
GREENVILLE SC
29615-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-882-2314
  • Fax: 864-882-3677
Mailing address:
  • Phone: 864-797-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20498
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: