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General NPI Number Information
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NPI Number | 1093288599
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Entity Type | Individual
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Provider Name | TONJA RENEE EVANS
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Gender | Female
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Dates
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Enumeration Date | 01/07/2019
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 99 HILL HAVEN RD
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City | GREENVILLE
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State | GA
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Zip | 30222-3107
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Country | US
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Telephone | 706-672-4241
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 370
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City | FORTSON
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State | GA
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Zip | 31808-0370
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Country | US
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Telephone |
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Fax | 706-494-3008
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT003156
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License Number State | GA
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