Individual
AKITA CARRIE EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
770 VILLAGE SQUARE DR, STONE MOUNTAIN, GA 30083-3380
(404) 298-8998
(404) 298-7658
Mailing address
770 VILLAGE SQUARE DR, STONE MOUNTAIN, GA 30083-3380
(404) 298-8998
(404) 298-7658
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
064372
GA
207Q00000X
Family Medicine Physician
141591
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141591
RESIDENT TRAINING LICENSE
NC
Enumeration date
05/28/2007
Last updated
02/13/2012
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