Provider Demographics
NPI:1316461379
Name:KING, EVAN (RNFA)
Entity type:Individual
Prefix:MR
First Name:EVAN
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 PIONEER TRL
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-3400
Mailing Address - Country:US
Mailing Address - Phone:256-601-6794
Mailing Address - Fax:
Practice Address - Street 1:52 PIONEER TRL
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068
Practice Address - Country:US
Practice Address - Phone:256-601-6794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN234991163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN234991OtherREGISTERED NURSE