Individual
JENNIFER EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
770 WALNUT ST, MACON, GA 31201-7307
(478) 787-4266
(478) 787-4199
Mailing address
PO BOX 4363, MACON, GA 31208-4363
(478) 787-4266
(478) 787-4199
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4152
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003134564A
—
GA
Enumeration date
06/10/2010
Last updated
05/28/2015
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