Provider Demographics
NPI:1336843499
Name:EVOLVE MANAGED CARE SOLUTIONS
Entity Type:Organization
Organization Name:EVOLVE MANAGED CARE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCFANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-297-0066
Mailing Address - Street 1:519 BLACKBURN DR STE 523
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-8202
Mailing Address - Country:US
Mailing Address - Phone:912-297-0066
Mailing Address - Fax:
Practice Address - Street 1:519 BLACKBURN DR STE 523
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-8202
Practice Address - Country:US
Practice Address - Phone:912-297-0066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty