Provider Demographics
NPI:1093166464
Name:BOOKER, EVELYN (RN)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:BOOKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 WILLIAMSON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-5471
Mailing Address - Country:US
Mailing Address - Phone:757-706-1776
Mailing Address - Fax:404-478-8864
Practice Address - Street 1:1705 WILLIAMSON RD STE 101
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-5471
Practice Address - Country:US
Practice Address - Phone:757-706-1776
Practice Address - Fax:404-478-8864
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN167813363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health