Glenn Hamilton Evans Sr., MD

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

License

034826 Issued in GA

Practice address

1305 Ocilla Rd
Douglas, GA 31533-2209

Phone

(912) 384-0600

Fax

(912) 384-0601

NPI assigned

Oct 18, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Cardiovascular Disease (Cardiology)Also: Interventional Cardiology

Education

Medical College of Georgia School of Medicine, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

CRH Physician Practices, LLCGroup PAC ID 5193727964, 38 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Coffee Regional Medical Center, Inc Hospital, Douglas, GA, CCN 110089
• SGMC Health Hospital, Valdosta, GA, CCN 110122
• SGMC Health Lanier Hospital, Lakeland, GA, CCN 111326
• SGMC Berrien Campus Hospital, Nashville, GA, CCN 110234

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: glenn.evans.1@9964.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• CRH Physician Practices, LLC

  • Multi-Specialty Clinic/Center
  • Douglas, GA
  • NPI 1710046073
  Medicare reassignment Care Compare group NPD
• Coffee Regional Medical Center, Inc

  • Anesthesiology Physician
  • Douglas, GA
  • NPI 1437120946
  Medicare reassignment NPD
• Valdosta Medical Clinic

  • Multi-Specialty Clinic/Center
  • Valdosta, GA
  • NPI 1538200035
  Medicare reassignment NPD
• Hospital Authority of Valdosta and Lowndes County Georgia

  • General Acute Care Hospital
  • Valdosta, GA
  • NPI 1306896253
  Medicare reassignment NPD (past)
• Coffee Regional Medical Center, Inc

  • Rural Health Clinic/Center
  • Douglas, GA
  • NPI 1639211956
  NPD
• CRH Physician Practices LLC

  • Multi-Specialty Clinic/Center
  • Nicholls, GA
  • NPI 1295095925
  NPD
• Hospital Authority of Valdosta and Lowndes County Georgia

  • Psychiatric Hospital Unit
  • Valdosta, GA
  • NPI 1033160791
  NPD
• Hospital Authority of Valdosta and Lowndes County, Georgia

  • Clinic/Center
  • Nashville, GA
  • NPI 1447591649
  NPD
• Hospital Authority of Valdosta and Lowndes County, Georgia

  • Ambulance
  • Valdosta, GA
  • NPI 1558141671
  NPD
• CRH Physician Practices LLC

  • Surgery Physician
  • Waycross, GA
  • NPI 1154794857
  NPD (past)
• Southern Heart Group

  • Cardiovascular Disease Physician
  • Jacksonville, FL
  • NPI 1962484220
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Coffee Regional Medical Center, Inc

  • General Acute Care Hospital
  • Douglas, GA
  • NPI 1760419527
  Care Compare affiliation
• South Georgia Medical Center Inc

  • General Acute Care Hospital
  • Valdosta, GA
  • NPI 1144096553
  Care Compare affiliation
• South Georgia Medical Center Inc

  • Critical Access Hospital
  • Lakeland, GA
  • NPI 1215703632
  Care Compare affiliation
• South Georgia Medical Center Inc

  • General Acute Care Hospital
  • Nashville, GA
  • NPI 1689440091
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656288000000",
    "number": "1285623744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1377",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315341377",
            "telephone_number": "912-384-1477",
            "fax_number": "912-384-1470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 OCILLA RD",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332209",
            "telephone_number": "912-384-0600",
            "fax_number": "912-384-0601"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3374 Greystone Way",
            "address_purpose": "LOCATION",
            "city": "Valdosta",
            "state": "GA",
            "postal_code": "316051096",
            "country_code": "US",
            "telephone_number": "912-384-0600",
            "fax_number": "912-384-0601",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1050 Valdosta Hwy",
            "address_purpose": "LOCATION",
            "city": "Homerville",
            "state": "GA",
            "postal_code": "316349701",
            "country_code": "US",
            "telephone_number": "912-384-6575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EVANS",
        "first_name": "GLENN",
        "middle_name": "HAMILTON",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-18",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "GA",
            "license": "034826",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "GA",
            "license": "034826",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony Forrest Ellis, PT
• Felicia Ellis, NP
• Emergency Physicians of Coffee County, LLC
• Envision Healthcare
• Katelin Ethridge, PHARMD
• Keri Evans, FNP-C
• Leslie Brooke Evans, FNP-C
• Faith Counseling
• Sarah Briceno Fambrough
• Kathryn Tucker Farabow, RPH

• Interventional Cardiology Physician in Douglas, GA
• Providers in Douglas, GA by specialty
• Interventional Cardiology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.