1013949205 NPI number — DR. EVANS PAUL PETERS D.C

Table of content: DR. EVANS PAUL PETERS D.C (NPI 1013949205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013949205 NPI number — DR. EVANS PAUL PETERS D.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETERS
Provider First Name:
EVANS
Provider Middle Name:
PAUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013949205
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3379 HIGHWAY 5
Provider Second Line Business Mailing Address:
SUITE I
Provider Business Mailing Address City Name:
DOUGLASVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30135-6928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-942-1883
Provider Business Mailing Address Fax Number:
770-942-3764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3379 HIGHWAY 5
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
DOUGLASVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30135-6928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-942-1883
Provider Business Practice Location Address Fax Number:
770-942-3764
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  GA2168 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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