Provider Demographics
NPI:1194334409
Name:AVILES, EVELYN (FNP-C)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:AVILES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4897 BUFORD HWY STE 167
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3670
Mailing Address - Country:US
Mailing Address - Phone:770-452-5642
Mailing Address - Fax:
Practice Address - Street 1:4897 BUFORD HWY STE 167
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-3670
Practice Address - Country:US
Practice Address - Phone:770-452-5642
Practice Address - Fax:770-452-5643
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN248435363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily