Provider Demographics
NPI:1700935293
Name:EVANS, ANGELA R (NP-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
Last Name:EVANS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 JOHNSON FY RD NE STE 110
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1607
Mailing Address - Country:US
Mailing Address - Phone:404-303-7004
Mailing Address - Fax:404-303-7020
Practice Address - Street 1:980 JOHNSON FY RD NE STE 110
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1607
Practice Address - Country:US
Practice Address - Phone:404-303-7004
Practice Address - Fax:404-303-7020
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1568163WS0121X
GA137531363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner