Individual
MR. CHARLES EDWARD EVANS III
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
P.T.A.
Contact information
Practice address
130 E BROAD ST, CAMILLA, GA 31730-1809
(229) 336-1115
(229) 336-1151
Mailing address
140 SAINT CLAIR DR, LEESBURG, GA 31763-3225
(229) 439-7337
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA001256
GA
Other
Enumeration date
03/16/2006
Last updated
07/08/2007
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