Provider Demographics
NPI:1881402170
Name:EVANS, DARRIN RAYNADA SR (LMT,CMT,MMT)
Entity type:Individual
Prefix:MR
First Name:DARRIN
Middle Name:RAYNADA
Last Name:EVANS
Suffix:SR
Gender:M
Credentials:LMT,CMT,MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 ROWE LN STE 101
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5572
Mailing Address - Country:US
Mailing Address - Phone:404-790-8181
Mailing Address - Fax:
Practice Address - Street 1:3545 ROWE LN STE 101
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5572
Practice Address - Country:US
Practice Address - Phone:404-790-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT009365225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist