Healthcare Provider Details

I. General information

NPI: 1609088947
Provider Name (Legal Business Name): JOHN YEISER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 22ND ST
COLUMBUS GA
31904-8823
US

IV. Provider business mailing address

802 22ND ST
COLUMBUS GA
31904-8823
US

V. Phone/Fax

Practice location:
  • Phone: 800-328-3044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number043511
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: