MEDICARE: MS. JENI F EVANS ATC

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
1	2255A2300X	Athletic Trainer	115	GA

General Provider Information

NPI Number	:	1508839549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENI F EVANS ATC

Provider Business Mailing Address
First Line	:	260 SEGREST CIR
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30605-3710
Country	:	US
Telephone Number	:	706-549-3821
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 CEDAR SHOOLS DR
Second Line	:	CEDAR SHOALS HIGH SCHOOL
City	:	ATHENS
State	:	GA
Zip	:	30605-3551
Country	:	US
Telephone Number	:	706-546-5375
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	07/08/2007

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