Individual
BRIAN CHRISTOPHER EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
270 CHASTAIN RD NW, KENNESAW, GA 30144-3012
(770) 421-8005
(770) 424-5662
Mailing address
270 CHASTAIN RD NW, KENNESAW, GA 30144-3012
(770) 421-8005
(770) 424-5662
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6022
GA
363AS0400X
Surgical Physician Assistant
006022
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202I971431
MEDICARE PTAN
GA
Enumeration date
12/27/2010
Last updated
05/03/2019
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