Healthcare Provider Details

I. General information

NPI: 1437762747
Provider Name (Legal Business Name): MR. JAMES L YANCEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 VERNON RD STE 400
LAGRANGE GA
30240-4129
US

IV. Provider business mailing address

112 N WILLOWCREST RD
LAGRANGE GA
30240-6341
US

V. Phone/Fax

Practice location:
  • Phone: 68-829-3417
  • Fax: 706-884-0131
Mailing address:
  • Phone: 706-333-9528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN269230
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: