Healthcare Provider Details

I. General information

NPI: 1528422649
Provider Name (Legal Business Name): DR. AMANDA YASSIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NORTHSIDE FORSYTH DR
CUMMING GA
30041-7668
US

IV. Provider business mailing address

6261 OAK RIDGE DR
FLOWERY BRANCH GA
30542-5038
US

V. Phone/Fax

Practice location:
  • Phone: 770-844-3200
  • Fax:
Mailing address:
  • Phone: 770-540-2668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License NumberRPH029000
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License NumberRP0007979
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License NumberPH.35771
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: