Provider Demographics
NPI:1992066013
Name:EVANS, NIA I (DPT)
Entity type:Individual
Prefix:MRS
First Name:NIA
Middle Name:I
Last Name:EVANS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:NIA
Other - Middle Name:I
Other - Last Name:SEIDU-CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:3029 BRASS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1043
Mailing Address - Country:US
Mailing Address - Phone:678-576-8982
Mailing Address - Fax:
Practice Address - Street 1:688 SPRING ST
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30354-1414
Practice Address - Country:US
Practice Address - Phone:404-881-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL271702251X0800X
GAPT010743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic