Provider Demographics
NPI:1568931038
Name:EVANS, WILLIAM P
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
Last Name:EVANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3979 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-6055
Mailing Address - Country:US
Mailing Address - Phone:601-317-4770
Mailing Address - Fax:601-878-3177
Practice Address - Street 1:3979 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-6055
Practice Address - Country:US
Practice Address - Phone:601-317-4770
Practice Address - Fax:601-878-3177
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)