MEDICARE: NOEL LEE 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	1891	TN

General Provider Information

NPI Number	:	1922510601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOEL LEE EVANS ATC

Provider Business Mailing Address
First Line	:	5709 SAN CRISTEBAL LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37921-7614
Country	:	US
Telephone Number	:	423-201-2237
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 TOWN CREEK RD E # 201
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-6289
Country	:	US
Telephone Number	:	423-201-2237
Fax Number	:

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

Provider Enumeration Date	:	11/02/2017
Last Update Date	:	11/02/2017

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