Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 68507 | GA |
NPI | 1073757589 |
---|---|
Provider Name | Amanda Mashae Evans |
First Address | Marietta, GA 30060-7940 |
Second Address | Marietta, GA 30060-1051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2009 |
Last Update Date | 16/10/2020 |