Provider Demographics
NPI:1699359604
Name:EVINS, CONNOR
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:EVINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CONNOR
Other - Middle Name:WILLIAM
Other - Last Name:EVINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-695-6697
Mailing Address - Fax:
Practice Address - Street 1:1208 AUGUSTA ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4084
Practice Address - Country:US
Practice Address - Phone:864-522-6200
Practice Address - Fax:864-522-6205
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC86028207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty