Provider Demographics
NPI:1437159456
Name:EVANS, WILLIAM SOUTHALL JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SOUTHALL
Last Name:EVANS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3481 MIKE PADGET HIGHWAY
Mailing Address - Street 2:AUGUSTA YDC
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906
Mailing Address - Country:US
Mailing Address - Phone:706-792-7587
Mailing Address - Fax:706-792-7586
Practice Address - Street 1:3481 MIKE PADGETT HWY
Practice Address - Street 2:AUGUSAT YOUTH DEVELOPMENT CAMPUS
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-3815
Practice Address - Country:US
Practice Address - Phone:706-792-7587
Practice Address - Fax:706-792-7586
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2014-08-04
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Provider Licenses
StateLicense IDTaxonomies
GA0327272084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry