Provider Demographics
NPI:1073241907
Name:EVOLVE SURGICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:EVOLVE SURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:DE'VON
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:706-616-4173
Mailing Address - Street 1:203 HEARTHSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-1363
Mailing Address - Country:US
Mailing Address - Phone:762-308-7622
Mailing Address - Fax:
Practice Address - Street 1:203 HEARTHSTONE DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-1363
Practice Address - Country:US
Practice Address - Phone:762-308-7622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty