Healthcare Provider Details

I. General information

NPI: 1720882046
Provider Name (Legal Business Name): ENDIA SIMONE YEARWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 HURRICANE SHOALS RD NE
LAWRENCEVILLE GA
30043-4851
US

IV. Provider business mailing address

1621 OLD SPRINGS CT
SNELLVILLE GA
30078-5965
US

V. Phone/Fax

Practice location:
  • Phone: 888-329-4535
  • Fax:
Mailing address:
  • Phone: 678-232-2637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: