MEDICARE: DR. STACY N EVANS MD

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	208000000X	Pediatrics Physician	051934	GA

General Provider Information

NPI Number	:	1538157631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACY N EVANS MD

Provider Business Mailing Address
First Line	:	271 BRENDA LN
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-1241
Country	:	US
Telephone Number	:	229-439-7396
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 N MONROE ST
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31701-1949
Country	:	US
Telephone Number	:	229-888-8121
Fax Number	:	229-888-6374

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. STACY N EVANS MD” Practice Location

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