Provider Demographics
NPI:1871782995
Name:EVANS, MICHAEL LEONARD (MSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEONARD
Last Name:EVANS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 CASTLEROCK WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4643
Mailing Address - Country:US
Mailing Address - Phone:770-914-4227
Mailing Address - Fax:770-914-4230
Practice Address - Street 1:1440 DUTCH VALLEY PL NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5366
Practice Address - Country:US
Practice Address - Phone:404-347-7264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker