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NPI Code Detail

MEDICARE: EVELYN FRANCES FAGAN

MEDICARE: EVELYN FRANCES FAGAN
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
1390200000XStudent in an Organized Health Care Education/Training ProgramGA

General Provider Information

NPI Number : 1932082237
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVELYN FRANCES FAGAN
Provider Business Mailing Address
First Line : 677 CHURCH ST NE
Second Line :
City : MARIETTA
State : GA
Zip : 30060-1101
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 677 CHURCH ST NE
Second Line :
City : MARIETTA
State : GA
Zip : 30060-1101
Country : US
Telephone Number : 770-793-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2025
Last Update Date : 04/07/2026

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Directions to “ EVELYN FRANCES FAGAN ” Practice Location

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