Provider Demographics
NPI:1558804054
Name:EVANS WINDSOR, CASSIDY MEGHAN (DAT, ATC)
Entity Type:Individual
Prefix:DR
First Name:CASSIDY
Middle Name:MEGHAN
Last Name:EVANS WINDSOR
Suffix:
Gender:F
Credentials:DAT, ATC
Other - Prefix:MS
Other - First Name:CASSIDY
Other - Middle Name:MEGHAN
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:134 DRURY LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8786
Mailing Address - Country:US
Mailing Address - Phone:907-982-5105
Mailing Address - Fax:
Practice Address - Street 1:134 DRURY LN
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8786
Practice Address - Country:US
Practice Address - Phone:907-982-5105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X, 390200000X
GAAT0041542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program