Provider Demographics
NPI:1063407450
Name:EVANS, PAMELA RUTH (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:RUTH
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:72 PHYSICIANS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2070
Mailing Address - Country:US
Mailing Address - Phone:731-668-4455
Mailing Address - Fax:731-664-4508
Practice Address - Street 1:300 HOSPITAL CIR STE 102
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4597
Practice Address - Country:US
Practice Address - Phone:731-644-8225
Practice Address - Fax:731-644-8228
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMC31994207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG55702Medicare UPIN
TN103I163636Medicare PIN
TNG55702Medicare UPIN
TN103I163636Medicare PIN
TN3846508Medicaid