Provider Demographics
NPI:1356043509
Name:EVANS ORTHOPEDIC CLINIC LLC
Entity type:Organization
Organization Name:EVANS ORTHOPEDIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:912-525-1281
Mailing Address - Street 1:4849 PAULSEN ST STE 304
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4426
Mailing Address - Country:US
Mailing Address - Phone:912-355-6615
Mailing Address - Fax:912-301-2013
Practice Address - Street 1:310 N RIVER ST
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-5920
Practice Address - Country:US
Practice Address - Phone:912-355-6615
Practice Address - Fax:855-645-0468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty