1245386945 NPI number — YAHYA SUBAYTI MD

Table of content: YAHYA SUBAYTI MD (NPI 1245386945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245386945 NPI number — YAHYA SUBAYTI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUBAYTI
Provider First Name:
YAHYA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1245386945
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 532893
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:
30353-2893
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-805-1300
Provider Business Mailing Address Fax Number:
904-805-1302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
631 R.B. WILSON DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGDON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38344-1727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-267-0011
Provider Business Practice Location Address Fax Number:
731-664-6590
Provider Enumeration Date:
01/26/2007

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: 207P00000X , with the licence number:  17358 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3840625 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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