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NPI Code Detail

MEDICARE: WILLIAM SOUTHALL EVANS JR. M.D.

MEDICARE: WILLIAM SOUTHALL EVANS JR. M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0804XChild & Adolescent Psychiatry Physician032727GA

General Provider Information

NPI Number : 1437159456
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM SOUTHALL EVANS JR. M.D.
Provider Business Mailing Address
First Line : 3481 MIKE PADGET HIGHWAY
Second Line : AUGUSTA YDC
City : AUGUSTA
State : GA
Zip : 30906
Country : US
Telephone Number : 706-792-7587
Fax Number : 706-792-7586
Provider Business Practice Location Address
First Line : 3481 MIKE PADGETT HWY
Second Line : AUGUSAT YOUTH DEVELOPMENT CAMPUS
City : AUGUSTA
State : GA
Zip : 30906-3815
Country : US
Telephone Number : 706-792-7587
Fax Number : 706-792-7586
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2005
Last Update Date : 08/04/2014

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