Provider Demographics
NPI:1851896617
Name:EVANS, CARY B (CCSH, RPSGT)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:B
Last Name:EVANS
Suffix:
Gender:M
Credentials:CCSH, RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 PINE STREET
Mailing Address - Street 2:STE. 900
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1103
Mailing Address - Country:US
Mailing Address - Phone:334-264-0222
Mailing Address - Fax:334-264-0295
Practice Address - Street 1:1722 PINE STREET
Practice Address - Street 2:STE. 900
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1103
Practice Address - Country:US
Practice Address - Phone:334-264-0222
Practice Address - Fax:334-264-0295
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1411246Z00000X
127174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other