1194770826 NPI number — ANTHONY J YANTCH PA-AA

Table of content: ANTHONY J YANTCH PA-AA (NPI 1194770826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194770826 NPI number — ANTHONY J YANTCH PA-AA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YANTCH
Provider First Name:
ANTHONY
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-AA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194770826
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 932925
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31193-2925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-364-9216
Provider Business Mailing Address Fax Number:
423-892-5838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 PARKWAY DR. NE
Provider Second Line Business Practice Location Address:
PMB 404
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30312-1212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-265-5620
Provider Business Practice Location Address Fax Number:
404-265-3894
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367H00000X , with the licence number:  000228 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100000419F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100000419D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1982637419 . This is a "GROUP NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: N334534 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: P00286235 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1194770826 . This is a "NPI" identifier , issued by the state of ( GU ) . This identifiers is of the category "OTHER".




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