Provider Demographics
NPI:1437460938
Name:EVANS, JAMES TRACY (D PH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:TRACY
Last Name:EVANS
Suffix:
Gender:M
Credentials:D PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 NEW HIGHWAY 68
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-2726
Mailing Address - Country:US
Mailing Address - Phone:423-351-1277
Mailing Address - Fax:423-351-1547
Practice Address - Street 1:929 NEW HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-2726
Practice Address - Country:US
Practice Address - Phone:423-351-1277
Practice Address - Fax:423-351-1547
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4054183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist