Provider Demographics
NPI:1093714586
Name:EVANS, GAIL A (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:A
Last Name:EVANS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 DILLON CIRCLE
Mailing Address - Street 2:DCG-IMT COE
Mailing Address - City:FORT EUSTIS
Mailing Address - State:VA
Mailing Address - Zip Code:23604
Mailing Address - Country:US
Mailing Address - Phone:912-429-7762
Mailing Address - Fax:
Practice Address - Street 1:210 DILLON CIRCLE
Practice Address - Street 2:DCG-IMT COE
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604
Practice Address - Country:US
Practice Address - Phone:912-429-7762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1036982363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical