Individual
DEBORAH EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2400 MOUNT ZION PKWY, KAISER PERMANENTE SOUTHWOOD MEDICAL CENTER, JONESBORO, GA 30236-2500
(404) 851-8000
Mailing address
3495 PIEDMONT RD NE, NINE PIEDMONT CENTER, ATLANTA, GA 30305-1717
(404) 504-5678
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002111
GA
363AM0700X
Medical Physician Assistant
002111
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01067986
AMERIGROUP
GA
05
—
100001096
—
GA
05
—
100001096A
—
GA
05
—
100001096B
—
GA
01
—
333478
WELLCARE
GA
Enumeration date
10/20/2006
Last updated
01/13/2022
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