MEDICARE: MRS. MELISSA ANN EVANS R.T.

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	247100000X	Radiologic Technologist	MDX0000006421	TN

General Provider Information

NPI Number	:	1972815470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA ANN EVANS R.T.

Provider Business Mailing Address
First Line	:	715 HORTON RD W
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-3424
Country	:	US
Telephone Number	:	256-996-3350
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 RIVERSIDE DR
Second Line	:	SUITE 120
City	:	CHATTANOOGA
State	:	TN
Zip	:	37406-4309
Country	:	US
Telephone Number	:	423-634-3110
Fax Number	:

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

Provider Enumeration Date	:	07/13/2010
Last Update Date	:	07/13/2010

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