Individual
DR. CHARLES E. EVANS III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
971 LAKELAND DR STE 1052, JACKSON, MS 39216-4609
(601) 981-9503
(601) 981-7895
Mailing address
971 LAKELAND DR STE 1052, JACKSON, MS 39216-4609
(601) 981-9503
(601) 981-7895
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
22904
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22904
STATE MEDICAL LICENSE
MS
Enumeration date
07/05/2011
Last updated
03/17/2018
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