Provider Demographics
NPI:1568035681
Name:EVANS, WILLIAM A (AGACNP-BC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:EVANS
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48089
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-8089
Mailing Address - Country:US
Mailing Address - Phone:706-389-3727
Mailing Address - Fax:706-389-3951
Practice Address - Street 1:2142 W BROAD ST BLDG 100 STE 200
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-3509
Practice Address - Country:US
Practice Address - Phone:706-548-6881
Practice Address - Fax:706-546-0821
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN275424363LA2200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
2021040471OtherANCC CERTIFICATION NUMBER
GARN275424OtherAPRN LICENSE NUMBER