Healthcare Provider Details

I. General information

NPI: 1972411247
Provider Name (Legal Business Name): YIVORY MEDICAL GROUP OF GEORGIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 CHATTAHOOCHEE AVE NW # B34
ATLANTA GA
30318-2829
US

IV. Provider business mailing address

1314 CHATTAHOOCHEE AVE NW APT B34
ATLANTA GA
30318-2829
US

V. Phone/Fax

Practice location:
  • Phone: 925-321-6353
  • Fax:
Mailing address:
  • Phone: 925-321-6353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: EYAD NAZER
Title or Position: OWNER
Credential: MD
Phone: 925-321-6353