Doctor Name: | STEPHANIE LAUREN EVANS |
NPI Number: | 1063828408 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 007185 |
Business Practice Address: | 1070 Historic Hwy 441 Suite D & E Demorest, GA - 30535 |
Business Phone Number: | 7067783912 |
Business Fax Number: | |
Mailing Address: | 3041 Belfaire Lake Dr, DACULA |
State: | GA |
Postal Code: | 300196729 |
Phone Number: | 4787197687 |
Fax Number: | |
NPI Enumeration Date: | 07/07/2014 |
NPI Last Update Date: | 07/07/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 007185 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |