Provider Demographics
NPI:1164563557
Name:MICHELLE EVANS, PC
Entity Type:Organization
Organization Name:MICHELLE EVANS, PC
Other - Org Name:EFM TO GO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-596-1218
Mailing Address - Street 1:105 COLLIER RD NW STE 1000
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1730
Mailing Address - Country:US
Mailing Address - Phone:404-596-1218
Mailing Address - Fax:855-594-2307
Practice Address - Street 1:105 COLLIER RD NW STE 1000
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1730
Practice Address - Country:US
Practice Address - Phone:404-596-1218
Practice Address - Fax:855-594-2307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052171207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7546OtherMEDICARE PTAN