Bennie Cleaveland Evans, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8495 Issued in GA

Practice address

210 Addavale St
Griffin, GA 30224-4217

Phone

(770) 229-1490

Fax

(770) 229-4929

NPI assigned

May 29, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Bennie C. Evans,D.D.S.,P.C.

  • General Practice Dentistry
  • Griffin, GA
  • NPI 1093819591
  NPD (past) Authorized official
• Addevale Family Dentistry, P.C.

  • General Practice Dentistry
  • Griffin, GA
  • NPI 1073057956
  NPD (past)

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

{
    "created_epoch": "1432857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432857600000",
    "number": "1730568296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 ADDAVALE ST",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302244217",
            "telephone_number": "770-229-1490",
            "fax_number": "770-229-4929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 ADDAVALE ST",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302244217",
            "telephone_number": "770-229-1490",
            "fax_number": "770-229-4929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "BENNIE",
        "middle_name": "CLEAVELAND",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-05-29",
        "last_updated": "2015-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "8495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheilah Isioma Esuzor-Avilez
• Eternal Hope Hospice
• Jaclyn Ethridge, LPC
• Dorothy G Eubanks, APRN
• Alanna Marie Evans-Gasses, PA
• Evernorth Direct Health LLC
• Expressions Speech Services, LLC
• Roselanda Exulus
• Eye Doctors Center, P.C.
• Adesola Omotayo Fabayo, M.D.

• General Practice Dentistry in Griffin, GA
• Providers in Griffin, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.