Provider Demographics
NPI:1326383050
Name:EVANS, CHLORA LEIGH (RN)
Entity Type:Individual
Prefix:MS
First Name:CHLORA
Middle Name:LEIGH
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 HILLANDALE DR
Mailing Address - Street 2:#1021
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-4927
Mailing Address - Country:US
Mailing Address - Phone:347-264-0483
Mailing Address - Fax:770-559-0913
Practice Address - Street 1:5850 HILLANDALE DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4927
Practice Address - Country:US
Practice Address - Phone:347-264-0483
Practice Address - Fax:770-559-0913
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA226424163WP0807X, 163W00000X, 163WA0400X, 163WC0400X, 163WC1500X, 163WC1600X, 163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support