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NPI Code Detail

MEDICARE: CHARLES A EVANS MD

MEDICARE: CHARLES A 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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician16284TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710953229
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES A EVANS MD
Provider Business Mailing Address
First Line : PO BOX 51530
Second Line :
City : KNOXVILLE
State : TN
Zip : 37950-1530
Country : US
Telephone Number : 865-766-8800
Fax Number : 865-450-9374
Provider Business Practice Location Address
First Line : 2333 MCCALLIE AVE
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37404-3258
Country : US
Telephone Number : 423-493-1550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2006
Last Update Date : 07/21/2014

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Directions to “ CHARLES A EVANS MD” Practice Location

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