Provider Demographics
NPI:1053414326
Name:EVANS, JEFFREY NEAL (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:NEAL
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2301 SOUTH LAMAR BLVD SUITE 100
Practice Address - Street 2:2301 SOUTH LAMAR BLVD SUITE 100
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-0768
Practice Address - Country:US
Practice Address - Phone:662-234-0119
Practice Address - Fax:662-234-0090
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12109207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302I290072Medicare PIN
MSF48440Medicare UPIN
MS00115527Medicaid
MSF48440Medicare UPIN
MS290000047Medicare ID - Type UnspecifiedMEDICARE ID