Provider Demographics
NPI:1497986558
Name:EVERSON, ERIN WURTZ
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:WURTZ
Last Name:EVERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 TURTLE CV
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116-1850
Mailing Address - Country:US
Mailing Address - Phone:229-942-2871
Mailing Address - Fax:
Practice Address - Street 1:406 COURTHOUSE SQUARE
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:GA
Practice Address - Zip Code:30113
Practice Address - Country:US
Practice Address - Phone:706-646-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician