Provider Demographics
NPI:1275769507
Name:EVANS, AMBER JO (MD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:JO
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 75947
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-0947
Mailing Address - Country:US
Mailing Address - Phone:901-516-8785
Mailing Address - Fax:901-516-8358
Practice Address - Street 1:1325 EASTMORELAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3519
Practice Address - Country:US
Practice Address - Phone:901-516-8785
Practice Address - Fax:901-516-8358
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN48966207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6042879OtherBCBS
TN6042879OtherBCBS