Provider Demographics
NPI:1285623744
Name:EVANS, GLENN HAMILTON SR (MD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:HAMILTON
Last Name:EVANS
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1377
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31534-1377
Mailing Address - Country:US
Mailing Address - Phone:912-384-1477
Mailing Address - Fax:912-384-1470
Practice Address - Street 1:1305 OCILLA RD
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2209
Practice Address - Country:US
Practice Address - Phone:912-384-0600
Practice Address - Fax:912-384-0601
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2022-06-27
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Provider Licenses
StateLicense IDTaxonomies
GA034826207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
F013496Medicare UPIN
06BDHRPMedicare Oscar/Certification