Provider Demographics
NPI:1407808314
Name:EVANS, ERIC E (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:E
Last Name:EVANS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E ARLINGTON BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5019
Mailing Address - Country:US
Mailing Address - Phone:252-695-0269
Mailing Address - Fax:252-413-0526
Practice Address - Street 1:150 E ARLINGTON BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858
Practice Address - Country:US
Practice Address - Phone:252-695-0269
Practice Address - Fax:252-413-0526
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00806363AM0700X, 363A00000X
VA0110001530363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical