Healthcare Provider Details

I. General information

NPI: 1831188929
Provider Name (Legal Business Name): MICHAEL ROBERT YOCHELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 PEACHTREE RD NW
ATLANTA GA
30309-1426
US

IV. Provider business mailing address

2020 PEACHTREE RD NW
ATLANTA GA
30309-1426
US

V. Phone/Fax

Practice location:
  • Phone: 404-352-2020
  • Fax: 404-350-7381
Mailing address:
  • Phone: 404-352-2020
  • Fax: 404-350-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberD51290
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberD51290
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD036431
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD078742
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: