Healthcare Provider Details

I. General information

NPI: 1497393797
Provider Name (Legal Business Name): ALLISON MARIE YOST FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

874 LANIER AVE W STE 220
FAYETTEVILLE GA
30214-7659
US

IV. Provider business mailing address

874 LANIER AVE W STE 220
FAYETTEVILLE GA
30214-7659
US

V. Phone/Fax

Practice location:
  • Phone: 678-833-1444
  • Fax:
Mailing address:
  • Phone: 678-833-1444
  • Fax: 678-833-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN223210
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: