Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 85897 | GA |
NPI | 1255759494 |
---|---|
Provider Name | Sean Spencer Evans |
First Address | Atlanta, GA 30329-2309 |
Second Address | Atlanta, GA 30329-2309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2014 |
Last Update Date | 25/06/2021 |