Provider Demographics
NPI:1245209444
Name:EVANS, PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3201 ST IVES COUNTRY CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:678-580-5137
Mailing Address - Fax:678-225-7509
Practice Address - Street 1:625 OLD PEACHTREE RD
Practice Address - Street 2:GEORGIA CAMPUS PCOM
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:678-225-7540
Practice Address - Fax:678-225-7509
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA55004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G87717Medicare UPIN