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Individual

JAKE L EVANS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
138 OAKLAND PKWY, LEESBURG, GA 31763-7200
(229) 432-2213
Mailing address
183 MIRROR LAKE RD, FITZGERALD, GA 31750-6160
(229) 325-4381

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN1015660
GA

Other

Enumeration date
06/28/2018
Last updated
06/28/2018
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