EVANS DERMATOLOGY LLC NPI 1083862577

NPI Information

  • NPI: 1083862577
  • Provider Name: EVANS DERMATOLOGY, LLC
  • Classification: Specialist - 174400000X
  • Entity Type: Organization
  • CLIA Number: 11D2041542
  • Address: 902 PONDER PLACE CT
    EVANS, GA
    ZIP 30809
  • Phone: (706) 922-3376

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NPI Details

EVANS DERMATOLOGY, LLC is a specialist in Evans, GA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. EVANS DERMATOLOGY, LLC NPI is 1083862577. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

902 PONDER PLACE CT
EVANS, GA
ZIP 30809-184
Phone: (706) 922-3376
Fax: (706) 922-5643

The provider's authorized official is Frances Florentino .
The authorized official title is Member and has the following contact phone number (407) 595-4859.

The CLIA number assigned to this NPI record is 11D2041542 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/9/2008 and was last updated on 11/7/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialist0576116GEORGIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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