Healthcare Provider Details

I. General information

NPI: 1679165716
Provider Name (Legal Business Name): YONISHA LEIGH WIMBERLY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987 SAINT SEBASTIAN WAY
AUGUSTA GA
30912-2613
US

IV. Provider business mailing address

2703 WASHINGTON RD
AUGUSTA GA
30909-2244
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3448
  • Fax:
Mailing address:
  • Phone: 706-737-4939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP231948
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN231948
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: