Healthcare Provider Details

I. General information

NPI: 1366975112
Provider Name (Legal Business Name): STEPHEN YANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2017
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 EXECUTIVE PARK DR NE
ATLANTA GA
30329
US

IV. Provider business mailing address

12 EXECUTIVE PARK DR NE
ATLANTA GA
30329-2206
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-5526
  • Fax:
Mailing address:
  • Phone: 404-778-5526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number325831
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number99525
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: