Evolutions on Fifth, LLC

Primary specialty

MechanotherapistTaxonomy code 172M00000X

Legal business name

EVOLUTIONS ON FIFTH, LLC

Practice address

122 5TH St N
Columbus, MS 39701-4522

Phone

(662) 630-5160

NPI assigned

Aug 18, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Jeff Bolling

Title

Director

Phone

(662) 497-0457

Specialties & licenses 1

Addresses

Other names 1

• Mississippi Mobile Vaccination Clinic Doing business as

Locations

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

{
    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629244800000",
    "number": "1346916632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 5TH ST N",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "397014522",
            "telephone_number": "662-630-5160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 5TH ST N",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "397014522",
            "telephone_number": "662-630-5160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLUTIONS ON FIFTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-18",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A",
        "authorized_official_last_name": "BOLLING",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "662-497-0457",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "172M00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Mechanotherapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mississippi Mobile Vaccination Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brian B Estes, CRNA
• Anna Evans, APRN
• Doria Johnson Evans
• Amanda Everett, NP-C
• Every Care Matters LLC
• Eye Laser & Surgery Center of Columbus, LLC
• Family Friend,LLC
• Peyton Fandel, DPT
• Farris Family Dentistry PLLC
• C. Chance Farris, DMD

• All providers in Columbus, MS
• Mechanotherapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.