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General NPI Number Information
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NPI Number | 1629580048
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Entity Type | Individual
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Provider Name | GRETCHEN FENNELL EVANS FNP
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Gender | Female
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Dates
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Enumeration Date | 10/25/2017
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 1800 HOG MOUNTAIN RD BLDG 200-101
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City | WATKINSVILLE
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State | GA
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Zip | 30677-1950
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Country | US
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Telephone | 706-769-9410
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Fax | 706-769-9475
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Provider Business Mailing Address
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Address Line | 154 HOLLY HILLS CT
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City | ATHENS
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State | GA
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Zip | 30606-3277
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Country | US
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Telephone | 706-202-0233
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Fax |
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | RN198578
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License Number State | GA
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