Healthcare Provider Details

I. General information

NPI: 1972068633
Provider Name (Legal Business Name): CHRISTOPHER YEGGE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 HOSPITAL SOUTH DR STE 202
AUSTELL GA
30106
US

IV. Provider business mailing address

1700 HOSPITAL SOUTH DR STE 202
AUSTELL GA
30106-8116
US

V. Phone/Fax

Practice location:
  • Phone: 770-944-7818
  • Fax: 770-944-6402
Mailing address:
  • Phone: 770-944-7818
  • Fax: 770-944-6402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number009208
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: