Healthcare Provider Details

I. General information

NPI: 1417605775
Provider Name (Legal Business Name): LEROYCE EVANS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MARYLAND FARMS STE 200
BRENTWOOD TN
37027-5780
US

IV. Provider business mailing address

3 MARYLAND FARMS STE 200
BRENTWOOD TN
37027-5780
US

V. Phone/Fax

Practice location:
  • Phone: 800-348-4565
  • Fax:
Mailing address:
  • Phone: 615-346-8738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: