Provider Demographics
NPI:1205461670
Name:EVANS-GASSES, ALANNA MARIE (PA)
Entity type:Individual
Prefix:
First Name:ALANNA
Middle Name:MARIE
Last Name:EVANS-GASSES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALANNA
Other - Middle Name:MARIE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 679
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-0679
Mailing Address - Country:US
Mailing Address - Phone:678-206-4136
Mailing Address - Fax:
Practice Address - Street 1:747 S HILL ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4830
Practice Address - Country:US
Practice Address - Phone:770-450-8878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9674363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant