Basic Information
| Provider Information | |||||||||
| NPI: | 1558318535 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 927 EAST BLVD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282035203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043775772 | ||||||||
| FaxNumber: | 7043773389 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 MALCOLM BLVD | ||||||||
| Address2: | |||||||||
| City: | VALDESE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286902872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285807620 | ||||||||
| FaxNumber: | 7043773389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 04/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | 2007-00819 | NC | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 208VP0014X | 27534 | SC | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5906671 | 05 | NC | MEDICAID | P01011051 | 01 | NC | RAILROAD-MEDICARE | OTHER | 147K8 | 01 | NC | BCBS | OTHER | 275348 | 05 | SC | MEDICAID |