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NPI Code Detail

MEDICARE: WALTER JACKSON EVANS II

MEDICARE: WALTER JACKSON EVANS II
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1588480958
Entity Type Code : Individual
Provider Name (Legal Business Name) : WALTER JACKSON EVANS II
Provider Business Mailing Address
First Line : PO BOX 740780
Second Line :
City : ATLANTA
State : GA
Zip : 30374-0780
Country : US
Telephone Number : 855-223-7123
Fax Number :
Provider Business Practice Location Address
First Line : 4927 CALLOWAY DR STE 102
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93312-9719
Country : US
Telephone Number : 661-380-7750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2024
Last Update Date : 05/26/2026

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Directions to “ WALTER JACKSON EVANS II ” Practice Location

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