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General NPI Number Information
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NPI Number | 1144407750
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Entity Type | Organization
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Legal Business Name | EVANS IMAGING, LLC
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Dates
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Enumeration Date | 01/25/2008
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Last Update Date | 12/11/2009
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Provider Practice Location Address
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Address Line | 4350 TOWNE CENTER DRIVE SUITE 1000
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City | EVANS
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State | GA
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Zip | 30809
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Country | US
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Telephone | 706-868-3940
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Fax | 706-868-3979
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Provider Business Mailing Address
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Address Line | 1125 TROUPE ST
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City | AUGUSTA
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State | GA
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Zip | 30904-4480
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Country | US
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Telephone | 706-737-4575
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Fax | 706-731-5289
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. STEVEN G. ROGERS
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Credential | M.D.
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Telephone | 706-737-4575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State | GA
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