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General NPI Number Information
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NPI Number | 1295342731
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Entity Type | Individual
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Provider Name | EVELYN ANITA ANDERSON
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Gender | Female
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Dates
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Enumeration Date | 09/29/2020
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 202 CHARLIE FULLER RD
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City | GRANTVILLE
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State | GA
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Zip | 30220-2801
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Country | US
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Telephone | 770-927-2290
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Fax | 404-522-2935
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Provider Business Mailing Address
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Address Line | 202 CHARLIE FULLER RD
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City | GRANTVILLE
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State | GA
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Zip | 30220-2801
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Country | US
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Telephone | 770-927-2290
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Fax | 404-522-2935
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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 | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | 113357
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License Number State | GA
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