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General NPI Number Information
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NPI Number | 1598083982
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Entity Type | Organization
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Legal Business Name | EVANS MEDICAL CLINIC, PLLC
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Dates
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Enumeration Date | 05/10/2010
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 3493 VETERANS DR N
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City | HUNTINGDON
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State | TN
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Zip | 38344-6227
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Country | US
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Telephone | 731-986-2933
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Fax | 731-986-2938
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Provider Business Mailing Address
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Address Line | PO BOX 465
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City | HUNTINGDON
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State | TN
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Zip | 38344-0465
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Country | US
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Telephone | 731-986-2933
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Fax | 731-986-2938
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS PAUL EVANS
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Credential | MD
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Telephone | 731-986-2933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD31824
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License Number State | TN
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