Provider Demographics
NPI:1851358337
Name:LANDIS, EVAN N (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:N
Last Name:LANDIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EVAN
Other - Middle Name:NEIL
Other - Last Name:LANDIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3400C OLD MILTON PKWY
Mailing Address - Street 2:STE 545
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:770-751-0800
Mailing Address - Fax:770-751-7198
Practice Address - Street 1:3400C OLD MILTON PKWY
Practice Address - Street 2:STE 545
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:770-751-0800
Practice Address - Fax:770-751-7198
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024010208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics