Healthcare Provider Details

I. General information

NPI: 1124314380
Provider Name (Legal Business Name): JESSICA ELAINE YEARBY RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 OLD PRETORIA RD
ALBANY GA
31721-9482
US

IV. Provider business mailing address

1122 OLD PRETORIA RD
ALBANY GA
31721-9482
US

V. Phone/Fax

Practice location:
  • Phone: 229-395-5135
  • Fax:
Mailing address:
  • Phone: 229-395-5135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number68880
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number11133
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number008204
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: