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General NPI Number Information
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NPI Number | 1720432743
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Entity Type | Individual
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Provider Name | MICHELLE EVANS ATC
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Gender | Female
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Dates
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Enumeration Date | 04/15/2016
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Last Update Date | 04/15/2016
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Provider Practice Location Address
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Address Line | 301 WIRE RD AUBURN SCHOOL OF KINESIOLOGY
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City | AUBURN
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State | AL
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Zip | 36849-5419
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Country | US
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Telephone | 334-844-4483
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2528
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City | TIFTON
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State | GA
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Zip | 31793-2528
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Country | US
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Telephone | 423-715-6715
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT002409
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License Number State | GA
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