Provider Demographics
NPI:1326335902
Name:EVANS, CHARLES E III (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:EVANS
Suffix:III
Gender:M
Credentials:DO
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Mailing Address - Street 1:971 LAKELAND DR STE 1052
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4609
Mailing Address - Country:US
Mailing Address - Phone:601-981-9503
Mailing Address - Fax:601-981-7895
Practice Address - Street 1:971 LAKELAND DR STE 1052
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4609
Practice Address - Country:US
Practice Address - Phone:601-981-9503
Practice Address - Fax:601-981-7895
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2018-03-17
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Provider Licenses
StateLicense IDTaxonomies
MS22904207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS22904OtherSTATE MEDICAL LICENSE