Provider Demographics
NPI:1801894779
Name:EVANS, THOMAS STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:STEPHEN
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-1181
Mailing Address - Country:US
Mailing Address - Phone:865-213-8595
Mailing Address - Fax:865-213-8596
Practice Address - Street 1:304 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-1181
Practice Address - Country:US
Practice Address - Phone:865-213-8595
Practice Address - Fax:865-213-8596
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3175370Medicaid
2006608OtherBLUE CROSS
TN3175370Medicaid
2006608OtherBLUE CROSS