Provider Demographics
NPI:1669640694
Name:EVAGASH, ANGELA MAY (DC)
Entity type:Individual
Prefix:DR
First Name:ANGELA MAY
Middle Name:
Last Name:EVAGASH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 E KING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6394
Mailing Address - Country:US
Mailing Address - Phone:912-729-2900
Mailing Address - Fax:912-729-2901
Practice Address - Street 1:575 E KING AVE
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6394
Practice Address - Country:US
Practice Address - Phone:912-729-2900
Practice Address - Fax:912-729-2901
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000934678AMedicaid
GA000934678AMedicaid