Healthcare Provider Details

I. General information

NPI: 1043297898
Provider Name (Legal Business Name): JOEL STEVEN YAUN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 S TALLAHASSEE ST
HAZLEHURST GA
31539-6465
US

IV. Provider business mailing address

PO BOX 1690
HAZLEHURST GA
31539-1690
US

V. Phone/Fax

Practice location:
  • Phone: 912-375-7781
  • Fax: 912-375-4055
Mailing address:
  • Phone: 912-375-7781
  • Fax: 912-375-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR152319
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: