Individual provider Active NPI

Joseph Bret Evans

  • Nurse Practitioner
  • Valdosta, GA
National Provider Identifier
1700353547
Registry record updated Oct 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN233841 Issued in GA
Practice address
410 Connell Rd
Valdosta, GA 31602-1898
Phone
(229) 244-4720
NPI assigned
Oct 30, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN233841 GA Primary

Addresses

Primary practice location

410 Connell Rd
Valdosta, GA 31602-1898

Mailing address

410 Connell Rd
Valdosta, GA 31602-1898
Phone (229) 244-4720

Other identifiers 1

IdentifierTypeStateIssuer
051405457OtherGADRIVERS LICENSE

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190410000965 GA Practitioner - Nurse Practitioner 7214278787 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN233841GAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
South Georgia Medical Associates, PC CurrentSince Jan 29, 2019 Accepting new patients

Locations

410 Connell Rd
Valdosta, GA 31602
Phone (229) 244-1570

Interoperability endpoints

  • Direct secure messaging: jospeh.evans@sgma.directbygreenway.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1540857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540857600000",
    "number": "1700353547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 CONNELL RD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021898",
            "telephone_number": "229-244-4720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 CONNELL RD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021898",
            "telephone_number": "229-244-4720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "JOSEPH",
        "middle_name": "BRET",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-30",
        "last_updated": "2018-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN233841",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVERS LICENSE",
            "identifier": "051405457",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

Verify at the official NPI Registry.