Provider Demographics
NPI:1659063576
Name:WEST, EVELYN C (SPECIALIST)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:C
Last Name:WEST
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 FAVOR RD SW # 2I02
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-5237
Mailing Address - Country:US
Mailing Address - Phone:513-882-2607
Mailing Address - Fax:
Practice Address - Street 1:2365 POWDER SPRINGS RD SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4567
Practice Address - Country:US
Practice Address - Phone:513-882-2607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management