Provider Demographics
NPI:1144952805
Name:EVANS, JOHNESIA (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:JOHNESIA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 POWELTON AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:GA
Mailing Address - Zip Code:31087-1546
Mailing Address - Country:US
Mailing Address - Phone:478-363-5750
Mailing Address - Fax:
Practice Address - Street 1:388 POWELTON AVE
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:GA
Practice Address - Zip Code:31087-1546
Practice Address - Country:US
Practice Address - Phone:478-363-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAB9H9Z6P8246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy