Evans, Genise Autry
Evans, Genise Autry is an individual health care provider with primary practice located at 1816 Lakefield Ct , Conyers GA 30013. She recently has only one registered license in Dental Providers / Dentist, which is considered as her primary health care specialty. Evans, Genise Autry can be contacted via phone (770) 860-8760.Contact Information
Primary practice address
1816 Lakefield Ct
Conyers GA 30013
Phone: (770) 860-8760
Fax: (678) 413-8144
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | DN012623 | Georgia |
Profile Details
| NPI number | 1548362718 |
|---|---|
| LBN Legal business name | Evans, Genise Autry |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 1st, 2006 |
| Last updated | Jul 8th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1548362718 | NPPES |
| Georgia | MEDICAID | 00957712E |
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