Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | 068097 | GA |
Y | 2080P0208X | Pediatric Infectious Diseases | 068097 | GA |
NPI | 1427250661 |
---|---|
Provider Name | Dr. Evan J Anderson |
First Address | Atlanta, GA 30322-0001 |
Second Address | Atlanta, GA 30322-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 02/07/2012 |