Provider Demographics
NPI:1205076163
Name:EVANS, C. SIMONE (DC)
Entity type:Individual
Prefix:
First Name:C.
Middle Name:SIMONE
Last Name:EVANS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2853 CANDLER RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-1433
Mailing Address - Country:US
Mailing Address - Phone:404-212-7332
Mailing Address - Fax:404-212-7694
Practice Address - Street 1:2853 CANDLER RD
Practice Address - Street 2:SUITE 5
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-1433
Practice Address - Country:US
Practice Address - Phone:404-212-7332
Practice Address - Fax:404-212-7694
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor