MEDICARE: JONATHAN G EVANS 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
1	207RP1001X	Pulmonary Disease Physician	MD27860	ME
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	24656	TN
3	207RP1001X	Pulmonary Disease Physician	MD0000024656	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	621632725	OTHER	TN	TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	621701777	OTHER	TN	TAX ID

General Provider Information

NPI Number	:	1568460640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN G EVANS M.D.

Provider Business Mailing Address
First Line	:	3443 DICKERSON PIKE
Second Line	:	SUITE 680
City	:	NASHVILLE
State	:	TN
Zip	:	37207-2519
Country	:	US
Telephone Number	:	615-865-3322
Fax Number	:	615-467-6692

Provider Business Practice Location Address
First Line	:	100 FODEN RD STE 103
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-2327
Country	:	US
Telephone Number	:	207-828-1122
Fax Number	:

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	02/12/2024

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Directions to “ JONATHAN G EVANS M.D.” Practice Location

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