Provider Demographics
NPI:1467722652
Name:EVELYN HIV WORLD CONSULT
Entity Type:Organization
Organization Name:EVELYN HIV WORLD CONSULT
Other - Org Name:EVELYN DOBSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-781-1956
Mailing Address - Street 1:2072 CUSTER DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-5018
Mailing Address - Country:US
Mailing Address - Phone:800-781-1956
Mailing Address - Fax:888-690-1333
Practice Address - Street 1:2072 CUSTER DR
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5018
Practice Address - Country:US
Practice Address - Phone:800-781-1956
Practice Address - Fax:888-690-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 332B00000X
MS332B00000X
TN332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty