MEDICARE: MISTY SHAWN 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
1	207R00000X	Internal Medicine Physician	33040	AZ
2	207R00000X	Internal Medicine Physician	89040	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1942293782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISTY SHAWN EVANS MD

Provider Business Mailing Address
First Line	:	5354 REYNOLDS ST
Second Line	:	STE 424
City	:	SAVANNAH
State	:	GA
Zip	:	31405-6011
Country	:	US
Telephone Number	:	602-445-0751
Fax Number	:	602-424-8128

Provider Business Practice Location Address
First Line	:	5354 REYNOLDS ST
Second Line	:	STE 424
City	:	SAVANNAH
State	:	GA
Zip	:	31405-6011
Country	:	US
Telephone Number	:	912-819-5999
Fax Number	:	912-819-5980

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	10/03/2023

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Directions to “ MISTY SHAWN EVANS MD” Practice Location

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