Healthcare Provider Details

I. General information

NPI: 1750474987
Provider Name (Legal Business Name): MONIKA S YADAV M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 SIXES RD STE 105
HOLLY SPRINGS GA
30115-8720
US

IV. Provider business mailing address

51 GORDON RD SUITE 201
JASPER GA
30143-1017
US

V. Phone/Fax

Practice location:
  • Phone: 678-494-9669
  • Fax:
Mailing address:
  • Phone: 706-692-9768
  • Fax: 706-692-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number054019
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: