1003029323 NPI number — ADAM EVEC DO

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003029323 NPI number — ADAM EVEC DO

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

EVEC

Provider First Name:

ADAM

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

DO

Provider Gender Code:

M

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:

1003029323

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/11/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 746639

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ATLANTA

Provider Business Mailing Address State Name:

GA

Provider Business Mailing Address Postal Code:

30374-6639

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

864-560-4304

Provider Business Mailing Address Fax Number:

864-560-4023

Provider First Line Business Practice Location Address:

101 E WOOD ST STE 500

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SPARTANBURG

Provider Business Practice Location Address State Name:

SC

Provider Business Practice Location Address Postal Code:

29303-3040

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

864-560-4304

Provider Business Practice Location Address Fax Number:

864-560-4023

Provider Enumeration Date:

05/07/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0200X , with the licence number:  1149 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207L00000X , with the licence number: 34008457 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207L00000X , with the licence number: 1149 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 000000527727 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 9833056 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 011490 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
• Identifier: 750546 . This is a "BUCKEYE MEDICAID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 0583328 . This is a "BCMH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 414968 . This is a "WELLCARE MEDICAID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 000000221387 . This is a "UNISON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 2762032 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: AA28435019 . This is a "MEDICARE PIN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".