Provider Demographics
NPI:1518473149
Name:EVANS, SONIA D
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:D
Last Name:EVANS
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 1:639 HEMLOCK ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-6889
Mailing Address - Country:US
Mailing Address - Phone:478-755-1560
Mailing Address - Fax:
Practice Address - Street 1:1282 S HOUSTON LAKE RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-2723
Practice Address - Country:US
Practice Address - Phone:478-313-3509
Practice Address - Fax:478-313-3517
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN169032363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner