=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992019780
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DON A EVANS MD /PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2010
-----------------------------------------------------
Last Update Date | 06/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 LOWELL DR SE STE 102
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35801-3755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-535-5976
-----------------------------------------------------
Fax | 256-535-5954
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 LOWELL DR SE STE 103
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35801-3755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-535-5976
-----------------------------------------------------
Fax | 256-535-5954
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DON A EVANS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 256-535-5976
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 7974
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------