Provider Demographics
NPI:1104966985
Name:HIGGINS, EVELYN MARY (DC)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:MARY
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4474 COMMERCE DR
Mailing Address - Street 2:STE A
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518
Mailing Address - Country:US
Mailing Address - Phone:678-546-8400
Mailing Address - Fax:678-546-8402
Practice Address - Street 1:4474 COMMERCE DR
Practice Address - Street 2:STE A
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518
Practice Address - Country:US
Practice Address - Phone:678-546-8400
Practice Address - Fax:678-546-8402
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA3034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA352CGXPMedicare ID - Type Unspecified