Individual
EVANNA PROCTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
620 SKYLINE DR, JACKSON, TN 38301-3923
(731) 422-0213
(731) 422-5743
Mailing address
PO BOX 400, JACKSON, TN 38302-0400
(731) 423-8697
(731) 422-5743
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD29082
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810262
—
TN
Enumeration date
03/08/2006
Last updated
10/09/2017
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