Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 009810 | GA |
NPI | 1225019565 |
---|---|
Provider Name | Dr. Donald C. Evans |
First Address | Cartersville, GA 30120-1691 |
Second Address | Cartersville, GA 30120-3469 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00081947B | (05) | GA |
D39819 | (02) | GA |