MEDICARE: MARK J. YANTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	043827	GA
2	207Y00000X	Otolaryngology Physician	43827	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3416408	OTHER	GA	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245239094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK J. YANTA M.D.

Provider Business Mailing Address
First Line	:	3400 OLD MILTON PKWY # C
Second Line	:	STE 365
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-3707
Country	:	US
Telephone Number	:	404-446-2400
Fax Number	:	404-446-2409

Provider Business Practice Location Address
First Line	:	3400 OLD MILTON PKWY # C
Second Line	:	STE 365
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-3707
Country	:	US
Telephone Number	:	404-446-2400
Fax Number	:	404-446-2409

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	02/01/2017

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Directions to “ MARK J. YANTA M.D.” Practice Location

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