Provider Demographics
NPI:1801007026
Name:EVANS, AKITA CARRIE (MD)
Entity Type:Individual
Prefix:
First Name:AKITA
Middle Name:CARRIE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:770 VILLAGE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3380
Mailing Address - Country:US
Mailing Address - Phone:404-298-8998
Mailing Address - Fax:404-298-7658
Practice Address - Street 1:770 VILLAGE SQUARE DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3380
Practice Address - Country:US
Practice Address - Phone:404-298-8998
Practice Address - Fax:404-298-7658
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC141591207Q00000X
GA064372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC141591OtherRESIDENT TRAINING LICENSE