Healthcare Provider Details

I. General information

NPI: 1619826419
Provider Name (Legal Business Name): MARTIN EDWARD EVANS RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARTY EVANS

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 WALNUT ST STE 150
CHATTANOOGA TN
37402-1314
US

IV. Provider business mailing address

974 COUNTY ROAD 609
ATHENS TN
37303-6365
US

V. Phone/Fax

Practice location:
  • Phone: 555-150-3740
  • Fax:
Mailing address:
  • Phone: 423-333-5791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: