Healthcare Provider Details

I. General information

NPI: 1932205879
Provider Name (Legal Business Name): HEMANT K. YAGNICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 TOWN PARK BOULEVARD SUITE 101
EVANS GA
30809
US

IV. Provider business mailing address

404 TOWN PARK BOULEVARD SUITE 101
EVANS GA
30809
US

V. Phone/Fax

Practice location:
  • Phone: 706-922-7246
  • Fax:
Mailing address:
  • Phone: 706-922-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number055321
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: