Healthcare Provider Details

I. General information

NPI: 1679581961
Provider Name (Legal Business Name): WILLIAM NORMAN YANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COCA COLA PLZ NW CCP234C
ATLANTA GA
30313-2420
US

IV. Provider business mailing address

734 WILDWOOD RD NE
ATLANTA GA
30324-4910
US

V. Phone/Fax

Practice location:
  • Phone: 404-515-5596
  • Fax: 404-515-4023
Mailing address:
  • Phone: 404-888-9696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number040594
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: