Provider Demographics
NPI:1376895813
Name:CHANCE, EVAN L (SERVICE COORDINATOR)
Entity Type:Individual
Prefix:MRS
First Name:EVAN
Middle Name:L
Last Name:CHANCE
Suffix:
Gender:F
Credentials:SERVICE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 PIPPIN PL
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30461-4914
Mailing Address - Country:US
Mailing Address - Phone:706-551-1097
Mailing Address - Fax:
Practice Address - Street 1:2003 PIPPIN PL
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30461-4914
Practice Address - Country:US
Practice Address - Phone:706-551-1097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator