Provider Demographics
NPI:1841892098
Name:EVANS, MEREDITH MARIE (NP-C)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:MARIE
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 1:55 WHITCHER ST NE STE 460
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1171
Mailing Address - Country:US
Mailing Address - Phone:678-388-1577
Mailing Address - Fax:770-427-1492
Practice Address - Street 1:55 WHITCHER ST NE STE 460
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1171
Practice Address - Country:US
Practice Address - Phone:678-388-1577
Practice Address - Fax:770-427-1492
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2023-09-14
Deactivation Date:2023-08-21
Deactivation Code:
Reactivation Date:2023-09-14
Provider Licenses
StateLicense IDTaxonomies
GARN257711363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN257711OtherGEORGIA SECRETARY OF STATE
F01211111OtherAANP