Provider Demographics
NPI:1477551026
Name:EVANS, S R III (MD)
Entity Type:Individual
Prefix:
First Name:S
Middle Name:R
Last Name:EVANS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 S STERLING ST STE 400
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4092
Mailing Address - Country:US
Mailing Address - Phone:828-580-4661
Mailing Address - Fax:828-580-4698
Practice Address - Street 1:2209 S STERLING ST STE 400
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4092
Practice Address - Country:US
Practice Address - Phone:828-580-4661
Practice Address - Fax:828-580-4698
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01049207V00000X
NC009000280207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1477551026Medicaid
NC5901162Medicaid
NC2044341CMedicare PIN