Provider Demographics
NPI:1568812287
Name:EVELYN, DANNA H
Entity Type:Individual
Prefix:MS
First Name:DANNA
Middle Name:H
Last Name:EVELYN
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 1:1302 LITTLE REFUGE RD
Mailing Address - Street 2:
Mailing Address - City:WALESKA
Mailing Address - State:GA
Mailing Address - Zip Code:30183-3024
Mailing Address - Country:US
Mailing Address - Phone:770-722-9538
Mailing Address - Fax:
Practice Address - Street 1:1302 LITTLE REFUGE RD
Practice Address - Street 2:
Practice Address - City:WALESKA
Practice Address - State:GA
Practice Address - Zip Code:30183-3024
Practice Address - Country:US
Practice Address - Phone:770-722-9538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator