Provider Demographics
NPI:1689930026
Name:EVATT, KYLE PHILLIP (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:PHILLIP
Last Name:EVATT
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 1657
Mailing Address - Street 2:PO BOX 800710
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-1657
Mailing Address - Country:US
Mailing Address - Phone:864-225-4601
Mailing Address - Fax:864-225-6998
Practice Address - Street 1:300C E GREENVILLE ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5534
Practice Address - Country:US
Practice Address - Phone:864-225-4601
Practice Address - Fax:864-225-6998
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD39368207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology