Provider Demographics
NPI:1700897485
Name:EVANS, AMY HURST (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:HURST
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 249
Mailing Address - Street 2:
Mailing Address - City:SEWANEE
Mailing Address - State:TN
Mailing Address - Zip Code:37375-2303
Mailing Address - Country:US
Mailing Address - Phone:931-598-9761
Mailing Address - Fax:931-598-5038
Practice Address - Street 1:1318 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SEWANEE
Practice Address - State:TN
Practice Address - Zip Code:37375-2336
Practice Address - Country:US
Practice Address - Phone:931-598-9761
Practice Address - Fax:931-598-5038
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD025878208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4049026OtherBLUE CROSS BLUE SHIELD
TNF96601Medicare UPIN