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General NPI Number Information
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NPI Number | 1881809077
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Entity Type | Individual
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Provider Name | RANDALL KEITH EVANS P.T.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 821 N COBB ST
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-2343
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Country | US
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Telephone | 478-454-3640
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Fax | 478-457-2005
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Provider Business Mailing Address
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Address Line | 1434 W HANCOCK ST UNIT A
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-6730
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Country | US
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Telephone | 478-696-3990
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT008605
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License Number State | GA
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