Individual
NATHANIEL R EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
210 VILLAGE CENTER BLVD STE 200, MYRTLE BEACH, SC 29579-6706
(843) 236-3222
(843) 236-3005
Mailing address
7221 HAGUE RD, INDIANAPOLIS, IN 46256-1925
(812) 240-4763
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
39886
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39886
SOUTH CAROLINA LICENSE
SC
Enumeration date
06/16/2011
Last updated
07/28/2016
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