Healthcare Provider Details

I. General information

NPI: 1386882538
Provider Name (Legal Business Name): DANNY YAKOUB M.B.,CH.B
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 01/12/2024
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST # OR6000
AUGUSTA GA
30912-5222
US

IV. Provider business mailing address

1120 15TH ST # OR6000
AUGUSTA GA
30912-0002
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3813
  • Fax:
Mailing address:
  • Phone: 706-721-3813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1153
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number68601
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number57791
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME118022
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number93968
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: