Provider Demographics
NPI:1952397101
Name:EVANS, WILLIAM GRAHAM JR (PAC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:GRAHAM
Last Name:EVANS
Suffix:JR
Gender:M
Credentials:PAC
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Mailing Address - Street 1:143 LOLA LN
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-8925
Mailing Address - Country:US
Mailing Address - Phone:252-726-2114
Mailing Address - Fax:
Practice Address - Street 1:1224 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-2405
Practice Address - Country:US
Practice Address - Phone:252-447-7474
Practice Address - Fax:252-447-1050
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC39759363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q05713Medicare UPIN