Individual
DR. CLINTON WILKINSON EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., D.M.D.
Contact information
Practice address
216 HEALTHWEST DR, DOTHAN, AL 36303-1942
(334) 792-1158
(334) 702-6983
Mailing address
35 HAMPTON WAY, DOTHAN, AL 36305-6319
(334) 792-1158
(334) 702-6983
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
22785
AL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
4563
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000095652
—
AL
01
—
51095652
BCBSAL DOTHAN OFFICE
AL
01
—
51097740
BCBSAL ENTERPRISE OFFICE
AL
01
—
766464
UNITED CONCORDIA
AL
Enumeration date
12/02/2005
Last updated
09/18/2012
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