Provider Demographics
NPI:1912484015
Name:EVANS, DONALD N III
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:N
Last Name:EVANS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-0402
Mailing Address - Country:US
Mailing Address - Phone:740-858-6683
Mailing Address - Fax:
Practice Address - Street 1:9620 CAREYS RUN POND CREEK RD
Practice Address - Street 2:
Practice Address - City:MC DERMOTT
Practice Address - State:OH
Practice Address - Zip Code:45652-3902
Practice Address - Country:US
Practice Address - Phone:740-858-6683
Practice Address - Fax:740-532-1715
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0303263Medicaid