Provider Demographics
NPI:1346371796
Name:EVANS, ANNE T (MS RN CS)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:T
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS RN CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:315 W PONCE DE LEON AV
Mailing Address - Street 2:STE 780
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030
Mailing Address - Country:US
Mailing Address - Phone:404-373-6222
Mailing Address - Fax:
Practice Address - Street 1:315 W PONCE DE LEON AV
Practice Address - Street 2:STE 780
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030
Practice Address - Country:US
Practice Address - Phone:404-373-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN033687364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
089BB7LMedicare ID - Type Unspecified
P38584Medicare UPIN