Provider Demographics
NPI:1013949205
Name:PETERS, EVANS PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:EVANS
Middle Name:PAUL
Last Name:PETERS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3379 HIGHWAY 5
Mailing Address - Street 2:SUITE I
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-6928
Mailing Address - Country:US
Mailing Address - Phone:770-942-1883
Mailing Address - Fax:770-942-3764
Practice Address - Street 1:3379 HIGHWAY 5
Practice Address - Street 2:SUITE I
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-6928
Practice Address - Country:US
Practice Address - Phone:770-942-1883
Practice Address - Fax:770-942-3764
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA2168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor