MEDICARE: MARY LAVINIA HARPER-YANCEY CHES

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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1790592954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LAVINIA HARPER-YANCEY CHES

Provider Business Mailing Address
First Line	:	1445 WOODMONT LN NW # 2875
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2866
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1445 WOODMONT LN NW # 2875
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2866
Country	:	US
Telephone Number	:	762-267-1975
Fax Number	:

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

Provider Enumeration Date	:	12/11/2024
Last Update Date	:	12/11/2024

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