Healthcare Provider Details

I. General information

NPI: 1063407450
Provider Name (Legal Business Name): PAMELA RUTH EVANS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HOSPITAL CIR STE 102
PARIS TN
38242-4597
US

IV. Provider business mailing address

72 PHYSICIANS DR
JACKSON TN
38305-2070
US

V. Phone/Fax

Practice location:
  • Phone: 731-644-8225
  • Fax: 731-644-8228
Mailing address:
  • Phone: 731-668-4455
  • Fax: 731-664-4508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMC31994
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: