Provider Demographics
NPI:1720432743
Name:EVANS, MICHELLE (ATC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2528
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-2528
Mailing Address - Country:US
Mailing Address - Phone:423-715-6715
Mailing Address - Fax:
Practice Address - Street 1:301 WIRE RD
Practice Address - Street 2:AUBURN SCHOOL OF KINESIOLOGY
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36849-5419
Practice Address - Country:US
Practice Address - Phone:334-844-4483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0024092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer