Provider Demographics
NPI:1508839549
Name:EVANS, JENI F (ATC)
Entity Type:Individual
Prefix:MS
First Name:JENI
Middle Name:F
Last Name:EVANS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 SEGREST CIR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3710
Mailing Address - Country:US
Mailing Address - Phone:706-549-3821
Mailing Address - Fax:
Practice Address - Street 1:1300 CEDAR SHOOLS DR
Practice Address - Street 2:CEDAR SHOALS HIGH SCHOOL
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3551
Practice Address - Country:US
Practice Address - Phone:706-546-5375
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer