Provider Demographics
NPI:1578734919
Name:EVANS, HARVEY J
Entity Type:Individual
Prefix:MR
First Name:HARVEY
Middle Name:J
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 1:218 TIMBERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-9311
Mailing Address - Country:US
Mailing Address - Phone:843-319-2413
Mailing Address - Fax:843-393-9914
Practice Address - Street 1:218 TIMBERLAKE DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-9311
Practice Address - Country:US
Practice Address - Phone:843-319-2413
Practice Address - Fax:843-393-9914
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCWP8949Medicaid