Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 2620 | AL |
NPI | 1205217577 |
---|---|
Provider Name | Thomas B Evely |
First Address | Birmingham, AL 35294-3409 |
Second Address | Kingsport, TN 37660-3837 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2015 |
Last Update Date | 15/11/2021 |