Provider Demographics
NPI:1831310861
Name:EVANS, MARCUS CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:CHRISTOPHER
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:770 PINE ST STE 290
Mailing Address - Street 2:ATTN: RADIOLOGY DEPARTMENT
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7516
Mailing Address - Country:US
Mailing Address - Phone:478-743-1458
Mailing Address - Fax:478-755-1332
Practice Address - Street 1:770 PINE ST STE 290
Practice Address - Street 2:ATTN: RADIOLOGY DEPARTMENT
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7516
Practice Address - Country:US
Practice Address - Phone:478-743-1458
Practice Address - Fax:478-755-1332
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA645362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA168151857BMedicaid
GA202I300186Medicare PIN