Provider Demographics
NPI: | 1619916301 |
---|---|
Name: | EVANS, HILARY JAMES (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | HILARY |
Middle Name: | JAMES |
Last Name: | EVANS |
Suffix: | |
Gender: | M |
Credentials: | MD |
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 743070 |
Mailing Address - Street 2: | |
Mailing Address - City: | ATLANTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30374-3070 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 864-560-4304 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 8311 WARREN H ABERNATHY HWY |
Practice Address - Street 2: | |
Practice Address - City: | SPARTANBURG |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29301-1249 |
Practice Address - Country: | US |
Practice Address - Phone: | 864-560-9435 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-06 |
Last Update Date: | 2020-12-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
SC | 27751 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
SC | 277514 | Medicaid | |
SC | P01402544 | Other | RAILROAD MEDICARE |
GA | P00386915 | Other | MEDICARE RAILROAD PTAN# |
GA | P00386915 | Other | MEDICARE RAILROAD PTAN# |
E86180 | Medicare UPIN | ||
SC | 277514 | Medicaid | |
SC | SC36655019 | Medicare PIN |