Provider Demographics
NPI:1255206645
Name:EVANS, CARLA MARSHELLE (MSM)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:MARSHELLE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 BOYKIN PL
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-4125
Mailing Address - Country:US
Mailing Address - Phone:706-945-6931
Mailing Address - Fax:706-945-0722
Practice Address - Street 1:338 GREENE ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1670
Practice Address - Country:US
Practice Address - Phone:706-303-4373
Practice Address - Fax:706-945-0722
Is Sole Proprietor?:No
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician