Healthcare Provider Details

I. General information

NPI: 1982969796
Provider Name (Legal Business Name): MARSHALYN YEARGIN-ALLSOPP M.D,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2012
Last Update Date: 05/19/2026
Certification Date:
Deactivation Date: 10/12/2012
Reactivation Date: 05/19/2026

III. Provider practice location address

1117 BATTLECREEK RD
JONESBORO GA
30236-2407
US

IV. Provider business mailing address

1117 BATTLECREEK RD
JONESBORO GA
30236-2407
US

V. Phone/Fax

Practice location:
  • Phone: 678-610-7234
  • Fax: 770-603-4174
Mailing address:
  • Phone: 678-610-7234
  • Fax: 770-603-4174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number16200
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: