Healthcare Provider Details

I. General information

NPI: 1225095664
Provider Name (Legal Business Name): DAVID WILLIAM YEAGER ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23653 LANES WAY
ATHENS AL
35613-6054
US

IV. Provider business mailing address

23653 LANES WAY
ATHENS AL
35613-6054
US

V. Phone/Fax

Practice location:
  • Phone: 256-874-2232
  • Fax:
Mailing address:
  • Phone: 256-874-2232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number831
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: