Provider Demographics
NPI:1255382719
Name:EVANS, ANN MARIE (NP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:EVANS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SUNSET DR STE 503
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2288
Mailing Address - Country:US
Mailing Address - Phone:706-613-1040
Mailing Address - Fax:706-613-9120
Practice Address - Street 1:ATHENS AREA SURGICAL ASSOCIATES, P.C.
Practice Address - Street 2:700 SUNSET DR., STE. 503
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2288
Practice Address - Country:US
Practice Address - Phone:706-613-1040
Practice Address - Fax:706-613-9120
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN138783363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBJFJMedicare ID - Type Unspecified
GA000968998BMedicaid
P65693Medicare UPIN